{"hospital_name":"HCA FLORIDA PUTNAM HOSPITAL","last_updated_on":"2024-10-01","version":"2.2.0","affirmation":{"affirmation":"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.","confirm_affirmation":true},"hospital_location":["HCA FLORIDA PUTNAM HOSPITAL"],"hospital_address":["611 Zeagler Drive, Palatka, FL, 32177"],"license_information":{"hospital_license_number":"4350","state":"FL"},"standard_charge_information":[{"description":"Abatacept injection ","code_information":[{"code":"9230","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":43.44,"maximum":52.12,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":47.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":44.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":52.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":47.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":49.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":43.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":45.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43.44,"methodology":"fee schedule"}]}]},{"description":"Acetylcholine receptor (AChR); binding antibody ","code_information":[{"code":"86041","type":"CPT"},{"code":"L000453402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.67,"maximum":22.08,"gross_charge":77.25,"discounted_cash":77.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"}]}]},{"description":"Activated Protein C (APC) resistance assay ","code_information":[{"code":"85307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.89,"maximum":18.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"ACUTE LEUKEMIA WITH OTHER PROCEDURES ","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":395929.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":69120.88,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":70806.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 15. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":71481.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 15. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":102070.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":129685.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":102070.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":68109.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":68109.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":147104.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":226238.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":147104.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":102070.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":74178.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":395929.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":163915.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":395929.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":71481.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 16+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":135406.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":68783.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":70806.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 15. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":72155.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":65411.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":70806.75,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":71481.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":84293.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":59873.45,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":74178.50,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":70806.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":74515.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":68783.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":64198.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":67435.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":74515.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":66086.30,"methodology":"fee schedule"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC ","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":84048.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15343.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15717.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15867.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15185.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19293.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15185.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15119.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15119.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":21885.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":33658.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21885.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15185.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16466.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":84048.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34796.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":84048.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15867.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28744.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15268.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15717.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16017.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14520.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15717.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15867.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18711.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12710.10,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16466.36,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15717.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16541.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15268.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":32870.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14250.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14969.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16541.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14670.03,"methodology":"fee schedule"}]}]},{"description":"Adenovirus vaccine type 4 ","code_information":[{"code":"9499","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":46.00,"maximum":55.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":47.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":49.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":48.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":46.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":46.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":50.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":49.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":50.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":46.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":49.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":55.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":50.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":52.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":48.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":46.00,"methodology":"fee schedule"}]}]},{"description":"Adrenocorticotropic hormone (ACTH) ","code_information":[{"code":"82024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35.01,"maximum":46.34,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":39.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":35.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":36.69,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":42.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":44.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":38.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":38.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":40.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":38.62,"methodology":"fee schedule"}]}]},{"description":"Aflibercept injection ","code_information":[{"code":"1420","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":821.98,"maximum":986.38,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":842.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":879.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":871.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":838.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":838.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":904.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":879.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":904.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":838.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":879.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":821.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":821.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":986.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":821.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":904.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":945.28,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":826.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":821.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":863.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":821.98,"methodology":"fee schedule"}]}]},{"description":"AICD GENERATOR PROCEDURES ","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":210036.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":37067.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37971.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38333.27,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":34358.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":43654.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":34358.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":36525.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":36525.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":49518.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":76156.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":49518.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":34358.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":39779.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":210036.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":86955.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":210036.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":38333.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":71831.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":36886.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37971.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":38694.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35078.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37971.63,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":38333.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":45204.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":31762.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":39779.81,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":37971.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":39960.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":36886.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":79727.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":34427.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36163.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39960.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35440.19,"methodology":"fee schedule"}]}]},{"description":"Albumin; ischemia modified ","code_information":[{"code":"82045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.76,"maximum":40.73,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":34.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":30.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":32.24,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":37.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":34.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":33.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33.94,"methodology":"fee schedule"}]}]},{"description":"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC ","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":17133.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14049.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14392.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14529.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4429.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":5627.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4429.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13844.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13844.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6383.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":9817.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6383.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4429.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15077.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14529.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13981.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14392.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14666.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13295.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14392.28,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14529.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17133.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11575.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15077.62,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14392.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15146.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13981.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13049.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13706.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15146.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13432.79,"methodology":"fee schedule"}]}]},{"description":"All potassium hydroxide (koh) preparations ","code_information":[{"code":"Q0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5.29,"maximum":7.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.83,"methodology":"fee schedule"}]}]},{"description":"Alpha 1 proteinase inhibi ","code_information":[{"code":"901","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.93,"maximum":5.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.06,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.93,"methodology":"fee schedule"}]}]},{"description":"Aluminum ","code_information":[{"code":"82108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.10,"maximum":30.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":23.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25.48,"methodology":"fee schedule"}]}]},{"description":"Amino acids; multiple, qualitative, each specimen ","code_information":[{"code":"82128","type":"CPT"},{"code":"L000084701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.57,"maximum":16.64,"gross_charge":381.25,"discounted_cash":381.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.87,"methodology":"fee schedule"}]}]},{"description":"Amniotic fluid scan (spectrophotometric) ","code_information":[{"code":"82143","type":"CPT"},{"code":"L000086401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.48,"maximum":11.22,"gross_charge":198.00,"discounted_cash":198.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.35,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC ","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":192752.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34087.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":34918.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35251.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21884.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":27806.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21884.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":33588.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":33588.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":31540.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":48507.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":31540.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21884.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":36581.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":192752.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":79799.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":192752.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35251.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 11+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":65920.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":33921.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":34918.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35583.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32258.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34918.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":35251.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":41569.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29148.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":36581.58,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":34918.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":36747.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":33921.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31659.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":33255.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36747.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32590.86,"methodology":"fee schedule"}]}]},{"description":"ANAL AND STOMAL PROCEDURES WITH MCC ","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":101723.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18391.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18839.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19019.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8091.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10280.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8091.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18122.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18122.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11661.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17934.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11661.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8091.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19736.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":101723.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":42113.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":101723.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19019.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":34789.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18301.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18839.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19198.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17404.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18839.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19019.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22428.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15382.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19736.97,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18839.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19826.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18301.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17081.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17942.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19826.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17583.85,"methodology":"fee schedule"}]}]},{"description":"Angiotensin I - converting enzyme (ACE) ","code_information":[{"code":"82164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.23,"maximum":17.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.60,"methodology":"fee schedule"}]}]},{"description":"Antibody identification; leukocyte antibodies ","code_information":[{"code":"86021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.64,"maximum":18.06,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, flow cytometry); qualitative assessment of the presence or absence of antibody(ies) to HLA Class I and ","code_information":[{"code":"86828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58.18,"maximum":77.03,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":68.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":68.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":68.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":58.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":77.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":60.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":73.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":67.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64.19,"methodology":"fee schedule"}]}]},{"description":"Antibody; Aspergillus ","code_information":[{"code":"86606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.64,"maximum":18.06,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"Antibody; Brucella ","code_information":[{"code":"86622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.09,"maximum":10.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.93,"methodology":"fee schedule"}]}]},{"description":"Antibody; cytomegalovirus (CMV) ","code_information":[{"code":"86644","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.05,"maximum":17.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"Antibody; enterovirus (eg, coxsackie, echo, polio) ","code_information":[{"code":"86658","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.81,"maximum":15.64,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.03,"methodology":"fee schedule"}]}]},{"description":"Antibody; Helicobacter pylori ","code_information":[{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.27,"maximum":20.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.85,"methodology":"fee schedule"}]}]},{"description":"Antibody; HIV-1 and HIV-2, single result ","code_information":[{"code":"86703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.43,"maximum":16.45,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.71,"methodology":"fee schedule"}]}]},{"description":"Antibody; Leishmania ","code_information":[{"code":"86717","type":"CPT"},{"code":"L000309501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.11,"maximum":14.70,"gross_charge":339.50,"discounted_cash":339.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.25,"methodology":"fee schedule"}]}]},{"description":"Antibody; Nocardia ","code_information":[{"code":"86744","type":"CPT"},{"code":"L000311801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.49,"maximum":19.19,"gross_charge":359.25,"discounted_cash":359.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.99,"methodology":"fee schedule"}]}]},{"description":"Antibody; rubeola ","code_information":[{"code":"86765","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.68,"maximum":15.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.88,"methodology":"fee schedule"}]}]},{"description":"Antibody; Trichinella ","code_information":[{"code":"86784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.39,"maximum":15.07,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.56,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test (Coombs test); direct, each antiserum ","code_information":[{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.12,"maximum":6.47,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"}]}]},{"description":"Antistreptolysin 0; titer ","code_information":[{"code":"86060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.62,"maximum":8.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.30,"methodology":"fee schedule"}]}]},{"description":"APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis ºFAP», attenuated FAP) gene analysis; full gene sequence ","code_information":[{"code":"81201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":741.00,"maximum":936.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":799.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":834.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":826.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":795.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":795.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":858.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":834.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":858.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":795.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":834.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":780.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":780.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":780.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":741.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":858.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":897.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":783.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":780.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":819.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":780.00,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; contrast baths, each 15 minutes ","code_information":[{"code":"97034","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.33,"maximum":16.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.74,"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":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":16.01,"maximum":19.22,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.01,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; vasopneumatic devices ","code_information":[{"code":"97016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.15,"maximum":13.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.49,"methodology":"fee schedule"}]}]},{"description":"Aquaporin-4 (neuromyelitis optica ºNMO») antibody; flow cytometry (ie, fluorescence-activated cell sorting ºFACS»), each ","code_information":[{"code":"86053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.19,"maximum":45.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"Argatroban nonesrd (accor ","code_information":[{"code":"9020","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.20,"maximum":5.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"}]}]},{"description":"Artiss fibrin sealant ","code_information":[{"code":"1848","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":138.35,"maximum":166.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":141.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":148.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":146.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":152.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":148.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":152.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":148.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":166.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":152.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":159.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":139.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":138.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":145.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":138.35,"methodology":"fee schedule"}]}]},{"description":"ATHEROSCLEROSIS WITH MCC ","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":49997.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9472.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9703.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9795.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8905.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11315.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8905.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9333.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9333.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12835.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19739.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12835.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8905.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10165.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49997.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20699.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49997.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9795.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17099.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9426.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9703.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9888.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8963.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9703.28,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9795.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11551.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7560.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10165.34,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9703.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10211.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9426.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8797.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9241.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10211.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9056.39,"methodology":"fee schedule"}]}]},{"description":"ATXN3 (ataxin 3) (eg, spinocerebellar ataxia, Machado-Joseph disease) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC ","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":259423.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":45583.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46695.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 16. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47139.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 16. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44916.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44916.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":48918.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":259423.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":107401.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":259423.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47139.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 17+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":88721.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":45361.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46695.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 16. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":47584.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43137.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46695.17,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":47139.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":55589.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":39230.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":48918.75,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":46695.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":49141.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":45361.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":44471.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":49141.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43582.16,"methodology":"fee schedule"}]}]},{"description":"BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROST ","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75225.43,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":29439.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27412.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":29439.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":23991.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28081.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28348.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":33938.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":43121.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":33938.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27011.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27011.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":48912.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":75225.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":48912.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":33938.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29418.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":41752.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":17286.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":41752.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28348.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":52681.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27278.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28081.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28616.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25941.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28081.17,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":28348.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33429.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23294.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29418.37,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":28081.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29552.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27278.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":34025.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25460.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26743.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29552.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26209.09,"methodology":"fee schedule"}]}]},{"description":"Basiliximab ","code_information":[{"code":"1683","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4588.77,"maximum":5506.52,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4703.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4909.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4864.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4680.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4680.55,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5047.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4909.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5047.65,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4680.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4909.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5506.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5047.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5277.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4611.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4588.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4818.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4588.77,"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":40.74,"maximum":50.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":46.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":46.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":44.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":40.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":50.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":46.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":48.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":42.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.00,"methodology":"fee schedule"}]}]},{"description":"Belimumab injection ","code_information":[{"code":"1353","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":54.15,"maximum":64.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":55.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":57.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":57.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":55.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":55.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":57.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":55.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":57.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":64.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":59.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":62.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":54.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":56.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":54.15,"methodology":"fee schedule"}]}]},{"description":"BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC ","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":263773.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":47460.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":46333.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":47460.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":38678.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":47463.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47915.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":49437.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":45393.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":40989.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":52079.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":40989.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":45655.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":45655.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":59074.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":90853.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":59074.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":40989.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":49723.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":263773.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":109202.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":263773.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47915.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":90209.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":46107.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":47463.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":48367.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43847.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":47463.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":47915.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":56504.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":39888.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":49723.67,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":47463.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":49949.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":46107.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":91960.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43033.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":45203.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":49949.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":44299.27,"methodology":"fee schedule"}]}]},{"description":"Bilirubin; direct ","code_information":[{"code":"82248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.55,"maximum":6.02,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"}]}]},{"description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care profe ","code_information":[{"code":"90912","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":66.64,"maximum":79.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":68.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":71.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":70.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":67.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":67.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":73.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":71.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":73.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":67.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":71.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":79.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":73.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":76.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":66.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":66.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":69.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":66.64,"methodology":"fee schedule"}]}]},{"description":"Blood component/product n ","code_information":[{"code":"9537","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":31.24,"maximum":37.49,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":31.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31.24,"methodology":"fee schedule"}]}]},{"description":"Blood count; leukocyte (WBC), automated ","code_information":[{"code":"85048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2.30,"maximum":3.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.54,"methodology":"fee schedule"}]}]},{"description":"Blood count; spun microhematocrit ","code_information":[{"code":"85013","type":"CPT"},{"code":"L000198501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.34,"maximum":8.40,"gross_charge":71.50,"discounted_cash":71.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.00,"methodology":"fee schedule"}]}]},{"description":"Blood, l/r, cmv-neg ","code_information":[{"code":"9524","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":167.25,"maximum":200.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":171.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":178.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":177.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":170.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":170.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":183.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":178.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":183.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":170.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":178.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":167.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":167.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":200.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":167.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":183.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":192.34,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":168.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":167.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":175.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":167.25,"methodology":"fee schedule"}]}]},{"description":"BONE DISEASES AND ARTHROPATHIES WITHOUT MCC ","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35873.61,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7036.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7208.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7277.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7091.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9010.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7091.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6933.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6933.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10220.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":15719.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10220.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7091.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7551.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35873.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14851.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35873.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7277.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12268.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7002.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7208.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7345.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6659.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7208.45,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7277.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8581.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5424.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7551.71,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7208.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7586.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7002.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6535.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6865.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7586.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6727.89,"methodology":"fee schedule"}]}]},{"description":"Brachytx, non-str, HA, P- ","code_information":[{"code":"2635","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":59.13,"maximum":70.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":60.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":63.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":62.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":60.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":60.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":63.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":60.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":63.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":70.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":68.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":59.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":59.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":62.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":59.13,"methodology":"fee schedule"}]}]},{"description":"Brachytx, stranded, C-131 ","code_information":[{"code":"2642","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":97.51,"maximum":117.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":99.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":104.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":99.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":99.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":107.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":104.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":107.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":99.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":104.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":97.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":97.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":117.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":97.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":107.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":112.14,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":98.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":97.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":102.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":97.51,"methodology":"fee schedule"}]}]},{"description":"BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis ","code_information":[{"code":"81165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":268.74,"maximum":339.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":339.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":268.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":325.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":284.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis ","code_information":[{"code":"81216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":175.86,"maximum":222.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":189.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":198.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":196.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":203.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":198.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":203.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":188.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":198.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":185.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":185.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":222.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":185.12,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":175.86,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":203.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":212.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":186.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":185.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":194.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":185.12,"methodology":"fee schedule"}]}]},{"description":"BRONCHITIS AND ASTHMA WITHOUT CC/MCC ","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":29929.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6011.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6158.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6217.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7979.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10138.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7979.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5923.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5923.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11500.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17686.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11500.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7979.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6451.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29929.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12390.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29929.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6217.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10235.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5982.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6158.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6275.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5689.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6158.44,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6217.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7331.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4525.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6451.70,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6158.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6481.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5982.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5583.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5865.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6481.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5747.88,"methodology":"fee schedule"}]}]},{"description":"C-reactive protein; ","code_information":[{"code":"86140","type":"CPT"},{"code":"L000225601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.69,"maximum":6.22,"gross_charge":55.00,"discounted_cash":55.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"Cadmium ","code_information":[{"code":"82300","type":"CPT"},{"code":"L000090201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":21.43,"maximum":28.37,"gross_charge":263.00,"discounted_cash":263.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22.46,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.64,"methodology":"fee schedule"}]}]},{"description":"Calcium; total ","code_information":[{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.68,"maximum":6.19,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.90,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.16,"methodology":"fee schedule"}]}]},{"description":"Cam release assembly, footrest or legrest, replacement only, each ","code_information":[{"code":"K0051","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":58.71,"maximum":72.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":64.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":64.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":66.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":64.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":66.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":61.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":64.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":60.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":60.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":58.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":72.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":60.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":66.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":69.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":60.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":60.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":63.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":60.53,"methodology":"fee schedule"}]}]},{"description":"Carbamazepine; -10,11-epoxide ","code_information":[{"code":"80161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.90,"maximum":22.37,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"Carcinoembryonic antigen (CEA) ","code_information":[{"code":"82378","type":"CPT"},{"code":"L000092001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.19,"maximum":22.75,"gross_charge":211.25,"discounted_cash":211.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.96,"methodology":"fee schedule"}]}]},{"description":"CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC ","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":39815.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7716.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7904.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7979.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8338.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10594.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8338.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7603.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7603.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12017.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18482.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12017.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8338.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8281.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":39815.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16483.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":39815.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7979.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13616.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7678.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7904.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8055.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7302.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7904.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7979.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9410.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6020.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8281.08,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7904.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8318.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7678.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7166.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7528.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8318.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7377.69,"methodology":"fee schedule"}]}]},{"description":"CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC ","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":120584.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21643.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22171.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22382.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21302.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":27065.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21302.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21326.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21326.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":30700.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":47216.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":30700.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21302.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23227.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":120584.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":49922.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":120584.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22382.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":41239.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21537.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22171.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22593.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20482.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22171.33,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":22382.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26394.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18235.10,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23227.10,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":22171.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23332.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21537.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":50501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20102.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21115.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23332.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20693.24,"methodology":"fee schedule"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA ","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":179666.17,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":111116.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":44943.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":111116.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":90555.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46039.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46477.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":126682.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":116319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":81058.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":102989.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":81058.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44285.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44285.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":116822.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":179666.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":116822.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":81058.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":48231.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173965.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72025.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173965.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46477.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":87451.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":44723.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46039.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":46916.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42531.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46039.20,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":46477.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":54808.57,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":38669.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":48231.55,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":46039.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":48450.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":44723.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":100144.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":41742.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":43846.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":48450.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42969.92,"methodology":"fee schedule"}]}]},{"description":"Cardiology (heart transplant), mRNA gene expression progiling by microarray of 1283 genes, transplant biopsy tissue, allograft rejection and injury algorithm reported as a probability score ","code_information":[{"code":"0087U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3001.45,"maximum":3791.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3238.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3380.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3348.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3222.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3222.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3475.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3380.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3475.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3222.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3380.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3791.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3001.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3475.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3633.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3175.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3317.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"}]}]},{"description":"Carnitine (total and free), quantitative, each specimen ","code_information":[{"code":"82379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.29,"maximum":20.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"Catecholamines; total urine ","code_information":[{"code":"82382","type":"CPT"},{"code":"L000092401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.74,"maximum":32.76,"gross_charge":472.75,"discounted_cash":472.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27.30,"methodology":"fee schedule"}]}]},{"description":"Ceftaroline fosamil inj ","code_information":[{"code":"1824","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3.94,"maximum":4.72,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.94,"methodology":"fee schedule"}]}]},{"description":"Centruroides immune f(ab) ","code_information":[{"code":"1431","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4804.24,"maximum":5765.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4924.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5140.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5092.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4900.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4900.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5284.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5140.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5284.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4900.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5140.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4804.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4804.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5765.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4804.24,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5284.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5524.88,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4828.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4804.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5044.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4804.24,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITH STERILIZATION WITH CC ","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47319.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8877.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":15492.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9094.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9180.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":21630.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":19860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21141.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26866.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21141.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8747.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8747.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28563.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26565.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28563.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21141.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9527.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19591.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9180.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11908.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8834.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9094.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9267.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8401.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9094.38,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":11580.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9180.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10826.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10270.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9527.44,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9094.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9570.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8834.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8245.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8661.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9570.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8488.08,"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":394.33,"maximum":522.08,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":465.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":461.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":443.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":443.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":478.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":465.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":478.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":443.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":465.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":394.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":522.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":413.32,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":478.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":500.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":437.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":456.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":435.07,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC ","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":63210.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11007.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11275.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11383.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":28518.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":36233.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":28518.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10846.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10846.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":41100.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":63210.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":41100.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":28518.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11812.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":58899.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24384.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":58899.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11383.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":20143.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10953.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11275.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11490.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10416.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11275.64,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11383.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13423.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8906.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11812.57,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11275.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11866.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10953.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10223.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10738.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11866.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10523.93,"methodology":"fee schedule"}]}]},{"description":"Chinstrap used with positive airway pressure device ","code_information":[{"code":"A7036","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":15.56,"maximum":19.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.04,"methodology":"fee schedule"}]}]},{"description":"CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC ","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":85020.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15511.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15889.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16040.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18898.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24011.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18898.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15284.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15284.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27236.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41888.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27236.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18898.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16646.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":85020.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":35198.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":85020.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16040.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":29076.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15435.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15889.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16192.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14678.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15889.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16040.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18916.04,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12857.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16646.11,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15889.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16721.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15435.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14406.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15132.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16721.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14830.17,"methodology":"fee schedule"}]}]},{"description":"Cholinesterase; serum ","code_information":[{"code":"82480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.13,"maximum":9.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.87,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (eg, diepoxybutane, mitomycin C, ionizing radiation, UV radiation) ","code_information":[{"code":"88249","type":"CPT"},{"code":"L000417701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":156.96,"maximum":207.80,"gross_charge":1273.00,"discounted_cash":1273.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":177.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":185.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":183.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":176.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":176.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":190.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":185.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":190.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":176.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":185.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":156.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":207.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":164.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":190.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":199.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":174.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":181.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":173.17,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding ","code_information":[{"code":"88262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113.74,"maximum":150.59,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":128.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":133.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":128.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":128.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":128.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":134.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":113.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":150.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":119.22,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":138.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":144.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":126.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":125.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":131.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":125.49,"methodology":"fee schedule"}]}]},{"description":"Ciprofloxacin otic susp 6 ","code_information":[{"code":"9479","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":30.02,"maximum":36.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":33.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.02,"methodology":"fee schedule"}]}]},{"description":"Clofarabine injection ","code_information":[{"code":"1710","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":14.38,"maximum":17.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.38,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; protein S, free ","code_information":[{"code":"85306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.89,"maximum":18.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.32,"methodology":"fee schedule"}]}]},{"description":"Electromagnetic therapy, to one or more areas for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healin ","code_information":[{"code":"G0329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10.00,"maximum":12.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.31,"methodology":"fee schedule"}]}]},{"description":"Endo, single, urinary tra ","code_information":[{"code":"2040","type":"APC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_percentage":38.27,"standard_charge_algorithm":"Reimbursement will be 38.27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_percentage":43.32,"standard_charge_algorithm":"Reimbursement will be 43.32% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_percentage":41.52,"standard_charge_algorithm":"Reimbursement will be 41.52% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_percentage":36.28,"standard_charge_algorithm":"Reimbursement will be 36.28% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_percentage":37.91,"standard_charge_algorithm":"Reimbursement will be 37.91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified; nonradioactive substrate, each specimen ","code_information":[{"code":"82657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.10,"maximum":26.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.17,"methodology":"fee schedule"}]}]},{"description":"Eptifibatide injection ","code_information":[{"code":"9420","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.15,"maximum":4.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.15,"methodology":"fee schedule"}]}]},{"description":"Estriol ","code_information":[{"code":"82677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.91,"maximum":29.02,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.18,"methodology":"fee schedule"}]}]},{"description":"Etiocholanolone ","code_information":[{"code":"82696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.78,"maximum":31.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":26.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":23.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.24,"methodology":"fee schedule"}]}]},{"description":"Evaluation of oral and pharyngeal swallowing function ","code_information":[{"code":"92610","type":"CPT"},{"code":"T000010601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":80.91,"maximum":100.08,"gross_charge":697.25,"discounted_cash":697.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":85.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":89.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":88.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":85.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":85.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":91.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":89.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":91.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":85.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":89.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":83.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":83.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":80.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":100.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":83.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":91.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":95.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":83.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":83.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":87.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":83.40,"methodology":"fee schedule"}]}]},{"description":"Exome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator exome (eg, parents, siblings) (List separately in addition to code for primary procedure) ","code_information":[{"code":"81416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10876.42,"maximum":14400.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12300.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12840.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12720.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12240.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12240.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13200.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12840.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13200.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12240.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12840.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12000.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12000.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10876.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14400.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12000.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11400.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13200.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13800.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12060.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12000.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12600.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12000.00,"methodology":"fee schedule"}]}]},{"description":"Extra heavy duty wheelchair ","code_information":[{"code":"K0007","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":164.99,"maximum":204.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":174.34,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":182.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":180.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":173.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":173.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":187.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":182.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":187.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":173.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":182.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":170.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":170.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":164.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":204.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":170.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":187.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":195.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":170.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":170.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":178.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":170.09,"methodology":"fee schedule"}]}]},{"description":"EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (eg, myelodysplastic syndrome, myeloproliferative neoplasms) gene analysis, full gene sequence ","code_information":[{"code":"81236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":268.74,"maximum":339.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":339.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":268.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":325.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":284.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"Factor inhibitor test ","code_information":[{"code":"85335","type":"CPT"},{"code":"L000204701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.67,"maximum":15.44,"gross_charge":354.50,"discounted_cash":354.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"Factor viia recomb novose ","code_information":[{"code":"1705","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.52,"maximum":3.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.52,"methodology":"fee schedule"}]}]},{"description":"Factor viii recombinant ","code_information":[{"code":"927","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.55,"maximum":1.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.55,"methodology":"fee schedule"}]}]},{"description":"Fatty acids, nonesterified ","code_information":[{"code":"82725","type":"CPT"},{"code":"L000113901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.01,"maximum":22.52,"gross_charge":237.75,"discounted_cash":237.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.77,"methodology":"fee schedule"}]}]},{"description":"Fetal aneuploidy (trisomy 13, 18, and 21), DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy, includes sex reporting, if performed ","code_information":[{"code":"0327U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":755.25,"maximum":954.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":814.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":850.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":842.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":810.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":810.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":874.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":850.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":874.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":810.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":850.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":954.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":755.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":874.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":914.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":798.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":795.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":834.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":795.00,"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":50.34,"maximum":66.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":59.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":58.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":61.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":59.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":61.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":59.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":50.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":66.65,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":52.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":61.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":63.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":55.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":55.54,"methodology":"fee schedule"}]}]},{"description":"FEVER AND INFLAMMATORY CONDITIONS ","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":38594.44,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7505.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7689.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7762.27,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10310.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13100.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10310.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7396.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7396.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14860.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22854.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14860.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10310.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8055.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":38594.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":15978.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38594.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7762.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13199.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7469.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7689.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7835.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7103.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7689.04,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7762.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9153.62,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5836.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8055.19,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7689.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8091.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7469.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6971.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7322.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8091.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7176.44,"methodology":"fee schedule"}]}]},{"description":"Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative ","code_information":[{"code":"85370","type":"CPT"},{"code":"L000205801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.26,"maximum":14.92,"gross_charge":295.00,"discounted_cash":295.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.43,"methodology":"fee schedule"}]}]},{"description":"Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay ","code_information":[{"code":"85420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.92,"maximum":7.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.53,"methodology":"fee schedule"}]}]},{"description":"Flexible endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; ","code_information":[{"code":"92616","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":213.56,"maximum":264.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":225.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":235.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":233.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":242.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":235.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":242.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":224.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":235.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":220.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":220.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":213.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":264.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":220.16,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":242.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":253.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":221.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":220.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":231.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":220.16,"methodology":"fee schedule"}]}]},{"description":"FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia), gene analysis; tyrosine kinase domain (TKD) variants (eg, D835, I836) ","code_information":[{"code":"81246","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78.85,"maximum":99.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":85.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":88.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":87.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":84.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":84.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":91.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":88.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":91.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":84.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":88.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":83.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":83.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":99.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":83.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":91.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":95.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":83.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":83.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":87.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":83.00,"methodology":"fee schedule"}]}]},{"description":"FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability ºXLID») gene analysis; characterization of alleles (eg, expanded size and promoter methylation ","code_information":[{"code":"81244","type":"CPT"},{"code":"L000052002","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":42.65,"maximum":53.87,"gross_charge":188.25,"discounted_cash":188.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":46.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":45.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":48.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":53.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":42.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":51.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":45.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":47.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":44.89,"methodology":"fee schedule"}]}]},{"description":"Footrest, complete assembly, replacement only, each ","code_information":[{"code":"K0045","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":63.78,"maximum":78.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":67.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":69.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":67.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":67.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":72.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":72.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":67.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":70.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":63.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":78.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":72.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":75.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":65.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":69.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":65.75,"methodology":"fee schedule"}]}]},{"description":"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WIT ","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":38413.91,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7474.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7657.16,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7730.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5715.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7261.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5715.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7365.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7365.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8237.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":12668.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8237.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5715.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8021.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":38413.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":15903.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38413.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7730.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13137.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7438.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7657.16,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7803.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7073.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7657.16,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7730.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9115.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5809.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8021.78,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7657.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8058.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7438.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6942.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7292.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8058.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7146.68,"methodology":"fee schedule"}]}]},{"description":"Frozen plasma, pooled, sd ","code_information":[{"code":"9509","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":60.46,"maximum":72.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":61.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":64.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":61.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":61.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":66.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":66.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":61.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":64.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":72.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":66.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":69.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":60.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":60.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":63.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":60.46,"methodology":"fee schedule"}]}]},{"description":"FXN (frataxin) (eg, Friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles ","code_information":[{"code":"81284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"Gabapentin, whole blood, serum, or plasma ","code_information":[{"code":"80171","type":"CPT"},{"code":"L000003701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":19.64,"maximum":26.00,"gross_charge":602.25,"discounted_cash":602.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":20.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.67,"methodology":"fee schedule"}]}]},{"description":"Galsulfase injection ","code_information":[{"code":"9224","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":484.75,"maximum":581.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":496.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":518.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":513.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":494.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":494.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":533.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":518.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":533.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":494.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":518.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":484.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":484.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":581.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":484.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":533.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":557.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":487.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":484.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":508.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":484.75,"methodology":"fee schedule"}]}]},{"description":"Gamunex-C/Gammaked ","code_information":[{"code":"948","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":48.80,"maximum":58.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":51.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":49.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":49.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":53.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":53.69,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":49.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":52.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":48.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":48.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":58.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":48.80,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":53.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":56.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":49.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":48.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":51.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":48.80,"methodology":"fee schedule"}]}]},{"description":"Gastrin after secretin stimulation ","code_information":[{"code":"82938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.03,"maximum":21.23,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.34,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.69,"methodology":"fee schedule"}]}]},{"description":"GASTROINTESTINAL OBSTRUCTION WITH MCC ","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":63185.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11746.10,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12032.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12147.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8402.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10676.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8402.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11574.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11574.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12110.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18624.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12110.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8402.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12605.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":63185.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":26158.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":63185.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12147.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":21609.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11688.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12032.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12261.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11115.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12032.59,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12147.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14324.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9555.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12605.57,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12032.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12662.87,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11688.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10909.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11459.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12662.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11230.42,"methodology":"fee schedule"}]}]},{"description":"Gen, neuro, clo loop, rec ","code_information":[{"code":"2038","type":"APC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_percentage":38.27,"standard_charge_algorithm":"Reimbursement will be 38.27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_percentage":43.32,"standard_charge_algorithm":"Reimbursement will be 43.32% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_percentage":41.52,"standard_charge_algorithm":"Reimbursement will be 41.52% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_percentage":36.28,"standard_charge_algorithm":"Reimbursement will be 36.28% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_percentage":37.91,"standard_charge_algorithm":"Reimbursement will be 37.91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Genome (eg, unexplained constitutional or heritable disorder or syndrome); re-evaluation of previously obtained genome sequence (eg, updated knowledge or unrelated condition/syndrome) ","code_information":[{"code":"81427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2118.77,"maximum":2805.18,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2396.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2501.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2477.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2384.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2384.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2571.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2501.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2571.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2384.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2501.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2337.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2337.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2118.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2805.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2337.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2220.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2571.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2688.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2349.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2337.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2454.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2337.65,"methodology":"fee schedule"}]}]},{"description":"Glassia injection ","code_information":[{"code":"1415","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5.58,"maximum":6.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.58,"methodology":"fee schedule"}]}]},{"description":"Glucose, body fluid, other than blood ","code_information":[{"code":"82945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.56,"maximum":4.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"Glucosidase, beta ","code_information":[{"code":"82963","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19.47,"maximum":25.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":20.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.48,"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":134.51,"maximum":178.09,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":152.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":158.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":157.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":163.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":158.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":163.25,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":158.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":134.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":178.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":140.99,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":163.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":170.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":149.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":155.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":148.41,"methodology":"fee schedule"}]}]},{"description":"Group caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (eg, activities of daily living ºADLs», instrumental ADLs ºiADLs», tra ","code_information":[{"code":"97552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.95,"maximum":25.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.60,"methodology":"fee schedule"}]}]},{"description":"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC ","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":64710.91,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12009.21,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12302.11,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12419.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5534.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7032.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5534.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11833.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11833.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":7977.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":12268.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":7977.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5534.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12887.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":64710.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":26790.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":64710.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12419.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22130.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11950.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12302.11,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12536.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11364.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12302.11,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12419.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14645.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9785.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12887.93,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12302.11,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12946.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11950.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11153.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11716.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12946.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11481.97,"methodology":"fee schedule"}]}]},{"description":"HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; known familial variant ","code_information":[{"code":"81258","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":356.49,"maximum":450.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":384.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":401.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":397.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":382.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":382.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":412.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":401.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":412.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":382.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":401.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":450.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":356.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":412.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":431.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":377.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":394.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":375.25,"methodology":"fee schedule"}]}]},{"description":"Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); duplication/deletion analysis panel, must include copy number analyses for STRC and DFNB1 deletions in GJB2 and GJB6 gen ","code_information":[{"code":"81431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":645.59,"maximum":815.48,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":696.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":727.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":720.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":693.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":693.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":747.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":727.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":747.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":693.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":727.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":679.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":679.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":815.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":679.57,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":645.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":747.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":781.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":682.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":679.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":713.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":679.57,"methodology":"fee schedule"}]}]},{"description":"Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); qualitative, any number of analytes ","code_information":[{"code":"83015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.98,"maximum":25.13,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.13,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19.89,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.94,"methodology":"fee schedule"}]}]},{"description":"Helicobacter pylori; drug administration ","code_information":[{"code":"83014","type":"CPT"},{"code":"L000121401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.12,"maximum":9.43,"gross_charge":218.00,"discounted_cash":218.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.47,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.86,"methodology":"fee schedule"}]}]},{"description":"Hematology (genetic platelet disorders), genomic sequence analysis of 43 genes, blood, buccal swab, or amniotic fluid ","code_information":[{"code":"0274U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":577.76,"maximum":729.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":623.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":644.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":729.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":577.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":699.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":611.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":638.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"}]}]},{"description":"Hematology, red blood cell (RBC) adhesion to endothelial/subendothelial adhesion molecules, functional assessment, whole blood with algorithmic analysis and result reported as an RBC adhesion index; h ","code_information":[{"code":"0303U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2091.54,"maximum":2641.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2256.66,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2355.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2333.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2245.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2245.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2421.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2355.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2421.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2245.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2355.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2201.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2201.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2641.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2201.62,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2091.54,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2421.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2531.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2212.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2201.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2311.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2201.62,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) ","code_information":[{"code":"83020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.67,"maximum":15.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; F (fetal), qualitative ","code_information":[{"code":"83033","type":"CPT"},{"code":"L000124101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.26,"maximum":9.60,"gross_charge":133.50,"discounted_cash":133.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.00,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; unstable, screen ","code_information":[{"code":"83068","type":"CPT"},{"code":"L000124901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.58,"maximum":11.36,"gross_charge":233.00,"discounted_cash":233.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.47,"methodology":"fee schedule"}]}]},{"description":"Hepagam b intravenous, in ","code_information":[{"code":"1138","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":68.66,"maximum":82.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":70.37,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":72.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":70.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":73.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":82.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":75.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":78.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":69.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":68.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":72.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":68.66,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B core antibody (HBcAb); total ","code_information":[{"code":"86704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.92,"maximum":14.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC ","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":151695.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27007.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27666.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27930.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":29121.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":37001.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":29121.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26612.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26612.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":41970.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":64548.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":41970.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":29121.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28984.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":151695.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":62802.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":151695.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27930.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":51879.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":26876.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27666.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28193.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25558.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27666.63,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":27930.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32936.46,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22939.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28984.09,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":27666.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29115.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26876.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25084.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26349.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29115.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25822.19,"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":645.10,"maximum":814.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":696.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":726.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":719.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":692.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":692.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":746.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":726.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":746.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":692.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":726.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":814.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":645.10,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":746.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":780.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":682.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":713.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":679.05,"methodology":"fee schedule"}]}]},{"description":"Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); duplication/deletion analysis panel, must include analy ","code_information":[{"code":"81438","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":416.98,"maximum":526.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":449.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":469.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":465.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":447.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":447.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":482.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":469.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":482.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":447.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":469.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":526.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":416.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":482.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":504.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":441.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":460.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":438.93,"methodology":"fee schedule"}]}]},{"description":"HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC ","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":73118.38,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13458.91,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13787.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13918.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11077.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14074.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11077.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13261.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13261.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15965.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24553.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15965.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11077.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14443.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":73118.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":30271.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":73118.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13918.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25006.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13393.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13787.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14049.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12736.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13787.17,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13918.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16413.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11057.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14443.70,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13787.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14509.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13393.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12500.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13130.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14509.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12868.03,"methodology":"fee schedule"}]}]},{"description":"High mount flip-up footrest, each ","code_information":[{"code":"K0037","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":52.91,"maximum":65.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":58.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":57.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":55.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":55.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":60.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":58.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":60.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":55.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":58.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":52.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":65.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":60.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":62.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":54.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":54.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":57.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":54.55,"methodology":"fee schedule"}]}]},{"description":"Hiv antigen/antibody, combination assay, screening ","code_information":[{"code":"G0475","type":"HCPCS"},{"code":"L000433901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":21.82,"maximum":28.90,"gross_charge":45.25,"discounted_cash":45.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.08,"methodology":"fee schedule"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC ","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":50777.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8284.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8486.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8567.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":22908.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":29106.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":22908.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8162.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8162.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":33016.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":50777.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":33016.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":22908.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8890.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":43107.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":17846.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":43107.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8567.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14742.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8243.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8486.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8647.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7839.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8486.23,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8567.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10102.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6518.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8890.34,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8486.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8930.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8243.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7694.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8082.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8930.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7920.48,"methodology":"fee schedule"}]}]},{"description":"HLA Class I typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-A, -B, or -C), each ","code_information":[{"code":"81380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":160.65,"maximum":212.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":181.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":189.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":187.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":180.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":180.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":194.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":189.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":194.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":180.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":189.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":160.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":212.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":168.39,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":194.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":178.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":177.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":186.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":177.25,"methodology":"fee schedule"}]}]},{"description":"HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each ","code_information":[{"code":"81376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110.77,"maximum":146.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":125.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":129.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":110.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":146.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":116.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":140.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":122.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":128.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"}]}]},{"description":"Homogenization, tissue, for culture ","code_information":[{"code":"87176","type":"CPT"},{"code":"L000347701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.33,"maximum":7.06,"gross_charge":180.00,"discounted_cash":180.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.76,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.88,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress ","code_information":[{"code":"E0303","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":270.76,"maximum":334.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":286.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":298.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":295.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":284.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":284.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":307.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":298.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":307.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":284.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":298.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":279.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":279.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":270.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":334.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":279.13,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":307.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":321.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":280.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":279.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":293.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":279.13,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress ","code_information":[{"code":"E0296","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":145.43,"maximum":179.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":153.68,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":160.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":158.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":152.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":152.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":164.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":160.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":164.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":152.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":160.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":149.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":149.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":145.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":179.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":149.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":164.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":172.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":150.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":149.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":157.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":149.93,"methodology":"fee schedule"}]}]},{"description":"HTT (huntingtin) (eg, Huntington disease) gene analysis; evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81271","type":"CPT"},{"code":"L000054902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"gross_charge":574.50,"discounted_cash":574.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"Human Platelet Antigen 3 genotyping (HPA-3), ITGA2B (integrin, alpha 2b ºplatelet glycoprotein IIb of IIb/IIIa complex», antigen CD41 ºGPIIb») (eg, neonatal alloimmune thrombocytopenia ºNAIT», post-tr ","code_information":[{"code":"81107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116.11,"maximum":146.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":125.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":129.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":146.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":116.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":140.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":122.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":128.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"}]}]},{"description":"Hydroxychloroquine ","code_information":[{"code":"80220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.90,"maximum":22.37,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"}]}]},{"description":"HYPERTENSION WITH MCC ","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":50496.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9558.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9791.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9884.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7050.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8958.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7050.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9418.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9418.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10161.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":15628.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10161.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7050.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10257.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":50496.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20905.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":50496.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9884.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17269.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9511.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9791.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9977.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9045.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9791.35,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9884.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11656.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7636.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10257.60,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9791.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10304.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9511.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8877.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9325.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10304.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9138.59,"methodology":"fee schedule"}]}]},{"description":"Ibutilide fumarate inject ","code_information":[{"code":"9044","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":241.40,"maximum":289.68,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":247.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":258.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":255.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":246.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":246.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":265.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":258.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":265.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":246.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":258.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":241.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":241.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":289.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":241.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":265.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":277.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":242.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":241.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":253.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":241.40,"methodology":"fee schedule"}]}]},{"description":"IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B-cell), gene rearrangement analysis to detect abnormal clonal population(s); amplified methodology (eg, polymerase chain reaction ","code_information":[{"code":"81261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":188.09,"maximum":237.59,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":202.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":211.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":209.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":201.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":201.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":211.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":201.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":211.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":197.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":197.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":237.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":197.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":188.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":217.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":227.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":198.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":197.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":207.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":197.99,"methodology":"fee schedule"}]}]},{"description":"Immune globulin, powder ","code_information":[{"code":"2731","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":82.19,"maximum":98.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":87.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":83.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":83.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":90.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":90.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":83.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":87.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":82.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":82.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":98.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":82.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":90.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":94.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":82.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":82.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":86.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":82.19,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each ","code_information":[{"code":"86316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.86,"maximum":24.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration ","code_information":[{"code":"86325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.96,"maximum":27.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":23.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.13,"methodology":"fee schedule"}]}]},{"description":"Imported lipodox inj ","code_information":[{"code":"1421","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":391.42,"maximum":469.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":401.21,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":418.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":414.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":399.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":399.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":430.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":418.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":430.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":399.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":418.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":391.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":391.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":469.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":391.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":430.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":450.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":393.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":391.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":410.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":391.42,"methodology":"fee schedule"}]}]},{"description":"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":27504.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5593.80,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5730.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5784.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8432.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10714.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8432.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5511.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5511.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12153.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18690.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12153.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8432.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6003.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":27504.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":11387.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":27504.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5784.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9406.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5566.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5730.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5839.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5293.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5730.23,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":5784.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6821.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4159.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6003.10,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":5730.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6030.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5566.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5195.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5457.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6030.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5348.22,"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":"87327","type":"CPT"},{"code":"L000359701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.16,"maximum":16.10,"gross_charge":329.25,"discounted_cash":329.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.42,"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"},{"code":"L000360601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.50,"maximum":19.20,"gross_charge":346.50,"discounted_cash":346.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.00,"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":"87391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19.85,"maximum":26.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":20.80,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.90,"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":10.85,"maximum":14.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"Inj, carmustine (accord) ","code_information":[{"code":"718","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":259.70,"maximum":311.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":266.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":277.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":275.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":264.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":264.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":277.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":264.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":277.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":311.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":285.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":298.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":261.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":259.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":272.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":259.70,"methodology":"fee schedule"}]}]},{"description":"Inj, cyclophosphamide, no ","code_information":[{"code":"743","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.01,"maximum":1.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.01,"methodology":"fee schedule"}]}]},{"description":"Inj, elranatamab-bcmm, 1 ","code_information":[{"code":"708","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":178.85,"maximum":214.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":183.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":191.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":189.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":182.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":182.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":196.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":191.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":196.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":182.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":191.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":178.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":178.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":214.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":178.85,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":196.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":205.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":179.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":178.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":187.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":178.85,"methodology":"fee schedule"}]}]},{"description":"Inj, fosaprepitant (teva) ","code_information":[{"code":"9166","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.04,"maximum":2.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.04,"methodology":"fee schedule"}]}]},{"description":"Inj, invega hafyera/trinz ","code_information":[{"code":"9145","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":12.66,"maximum":15.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.66,"methodology":"fee schedule"}]}]},{"description":"Inj, lenacapavir, 1 mg ","code_information":[{"code":"9155","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":21.99,"maximum":26.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"}]}]},{"description":"Inj, motixafortide, 0.25 ","code_information":[{"code":"729","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":25.22,"maximum":30.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":27.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25.22,"methodology":"fee schedule"}]}]},{"description":"Inj, Omacetaxine Mep, 0.0 ","code_information":[{"code":"9297","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.03,"maximum":4.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.03,"methodology":"fee schedule"}]}]},{"description":"Inj, releuko 1 mcg ","code_information":[{"code":"9447","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.47,"maximum":0.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":0.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":0.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.47,"methodology":"fee schedule"}]}]},{"description":"Inj, stimufend, 0.5 mg ","code_information":[{"code":"9129","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":305.66,"maximum":366.79,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":313.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":327.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":324.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":311.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":311.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":336.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":327.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":336.22,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":311.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":327.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":305.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":305.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":366.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":305.66,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":336.22,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":351.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":307.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":305.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":320.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":305.66,"methodology":"fee schedule"}]}]},{"description":"Inj, toripalimab-tpzi, 1 ","code_information":[{"code":"745","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":38.87,"maximum":46.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":39.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":39.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":39.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":39.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":44.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":39.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":38.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":40.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":38.87,"methodology":"fee schedule"}]}]},{"description":"Inj, vasopressin, 1 unit ","code_information":[{"code":"1233","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.62,"maximum":1.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.62,"methodology":"fee schedule"}]}]},{"description":"Inj. avsola, 10 mg ","code_information":[{"code":"9381","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":21.29,"maximum":25.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.29,"methodology":"fee schedule"}]}]},{"description":"Inj. inebilizumab-cdon, 1 ","code_information":[{"code":"9394","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":484.40,"maximum":581.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":496.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":518.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":513.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":494.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":494.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":532.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":518.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":532.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":494.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":518.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":484.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":484.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":581.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":484.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":532.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":557.06,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":486.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":484.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":508.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":484.40,"methodology":"fee schedule"}]}]},{"description":"Inj. naxitamab-gqgk, 1 mg ","code_information":[{"code":"9408","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":642.15,"maximum":770.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":658.20,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":687.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":680.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":654.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":654.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":706.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":687.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":706.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":654.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":687.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":770.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":706.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":738.47,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":645.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":642.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":674.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":642.15,"methodology":"fee schedule"}]}]},{"description":"Inj. tigecycline (accord) ","code_information":[{"code":"9220","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.65,"maximum":3.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.65,"methodology":"fee schedule"}]}]},{"description":"Inj., cemiplimab-rwlc, 1 ","code_information":[{"code":"9304","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":28.24,"maximum":33.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":28.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":31.06,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28.24,"methodology":"fee schedule"}]}]},{"description":"Inj., fremanezumab-vfrm 1 ","code_information":[{"code":"9197","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.85,"maximum":2.22,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.85,"methodology":"fee schedule"}]}]},{"description":"Inj., perseris, 0.5 mg ","code_information":[{"code":"9181","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":12.19,"maximum":14.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.19,"methodology":"fee schedule"}]}]},{"description":"Inj., triptorelin xr 3.75 ","code_information":[{"code":"9016","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3418.49,"maximum":4102.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3503.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3657.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3623.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3486.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3486.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3760.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3657.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3760.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3486.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3657.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3418.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3418.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4102.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3418.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3760.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3931.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3435.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3418.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3589.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3418.49,"methodology":"fee schedule"}]}]},{"description":"Injection, aztreonam, 100 ","code_information":[{"code":"9288","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.97,"maximum":2.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.97,"methodology":"fee schedule"}]}]},{"description":"Injection, casimersen, 10 ","code_information":[{"code":"9412","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":166.22,"maximum":199.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":170.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":177.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":176.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":182.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":177.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":182.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":169.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":177.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":199.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":182.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":191.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":167.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":166.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":174.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":166.22,"methodology":"fee schedule"}]}]},{"description":"Injection, inflectra ","code_information":[{"code":"1847","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":13.62,"maximum":16.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.62,"methodology":"fee schedule"}]}]},{"description":"Injection, oritavancin ","code_information":[{"code":"1660","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":28.46,"maximum":34.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34.15,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":31.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28.46,"methodology":"fee schedule"}]}]},{"description":"Injection, ruconest ","code_information":[{"code":"9445","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":34.72,"maximum":41.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":39.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":34.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34.72,"methodology":"fee schedule"}]}]},{"description":"Instill, bupivac and melo ","code_information":[{"code":"9440","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.77,"maximum":0.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":0.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":0.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.88,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.77,"methodology":"fee schedule"}]}]},{"description":"Intensive Outpatient (3 s ","code_information":[{"code":"5861","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":250.36,"maximum":300.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":256.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":265.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":300.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":287.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":251.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":262.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC ","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":30105.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6042.20,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6189.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6248.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9575.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12165.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9575.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5953.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5953.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13799.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21223.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13799.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9575.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6484.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":30105.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12463.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":30105.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6248.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10295.88,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6012.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6189.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6307.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5717.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6189.57,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6248.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7368.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4552.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6484.31,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6189.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6513.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6012.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5611.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5894.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6513.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5776.93,"methodology":"fee schedule"}]}]},{"description":"INTRAOCULAR PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":46361.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8845.23,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9060.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9147.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7249.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9210.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7249.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8715.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8715.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10447.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16067.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10447.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7249.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9492.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46361.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19193.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":46361.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9147.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15855.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8802.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9060.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9233.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8370.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9060.97,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9147.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10786.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7010.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9492.44,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9060.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9535.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8802.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8215.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8629.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9535.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8456.91,"methodology":"fee schedule"}]}]},{"description":"Iron stain, peripheral blood ","code_information":[{"code":"85536","type":"CPT"},{"code":"L000208801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.24,"maximum":8.26,"gross_charge":183.00,"discounted_cash":183.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.88,"methodology":"fee schedule"}]}]},{"description":"Iv pole ","code_information":[{"code":"E0776","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":178.97,"maximum":221.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":189.12,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":197.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":195.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":188.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":188.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":202.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":197.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":202.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":188.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":197.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":184.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":184.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":178.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":221.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":184.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":202.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":212.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":185.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":184.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":193.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":184.51,"methodology":"fee schedule"}]}]},{"description":"Ketosteroids, 17- (17-KS); total ","code_information":[{"code":"83586","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.60,"maximum":15.36,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.08,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.80,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC ","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":34498.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6799.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6965.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7031.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7752.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9849.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7752.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6700.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6700.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11172.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17182.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11172.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7752.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7297.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":34498.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14282.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":34498.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7031.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11798.22,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6766.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6965.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7098.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6434.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6965.50,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7031.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8292.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5216.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7297.19,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6965.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7330.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6766.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6315.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6633.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7330.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6501.13,"methodology":"fee schedule"}]}]},{"description":"KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC ","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":149245.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26585.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27233.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27493.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":51268.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":65139.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":51268.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26196.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26196.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":73888.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":113636.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":73888.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":51268.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28530.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":149245.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":61787.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":149245.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27493.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":51041.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":26455.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27233.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27752.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25158.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27233.86,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":27493.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32421.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22569.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28530.71,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":27233.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28660.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26455.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25937.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28660.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25418.27,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf ","code_information":[{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":93.28,"maximum":115.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":98.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":102.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":101.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":98.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":98.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":105.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":102.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":105.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":98.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":102.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":96.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":96.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":93.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":115.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":96.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":105.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":110.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":96.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":96.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":100.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":96.17,"methodology":"fee schedule"}]}]},{"description":"KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg, carcinoma) gene analysis; additional variant(s) (eg, codon 61, codon 146) ","code_information":[{"code":"81276","type":"CPT"},{"code":"L000055502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":175.15,"maximum":231.90,"gross_charge":298.75,"discounted_cash":298.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":198.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":204.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":175.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":231.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":183.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":194.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":202.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":193.25,"methodology":"fee schedule"}]}]},{"description":"Lactogen, human placental (HPL) human chorionic somatomammotropin ","code_information":[{"code":"83632","type":"CPT"},{"code":"L000164501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":18.32,"maximum":24.26,"gross_charge":557.00,"discounted_cash":557.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.22,"methodology":"fee schedule"}]}]},{"description":"Large volume nebulizer, disposable, unfilled, used with aerosol compressor ","code_information":[{"code":"A7007","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":4.76,"maximum":5.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.91,"methodology":"fee schedule"}]}]},{"description":"Leg strap, each ","code_information":[{"code":"K0038","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":27.36,"maximum":33.85,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":28.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":27.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28.21,"methodology":"fee schedule"}]}]},{"description":"Leuprolide acetate injeci ","code_information":[{"code":"9047","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":9.20,"maximum":11.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.20,"methodology":"fee schedule"}]}]},{"description":"Level 1 Diagnostic Tests ","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":143.79,"maximum":172.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":147.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":153.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":152.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":146.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":146.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":158.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":153.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":158.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":146.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":153.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":143.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":143.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":172.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":143.79,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":158.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":165.36,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":144.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":143.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":150.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":143.79,"methodology":"fee schedule"}]}]},{"description":"Level 1 Gynecologic Proce ","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":183.44,"maximum":220.12,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":188.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":196.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":194.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":187.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":187.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":201.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":196.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":201.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":187.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":196.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":183.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":183.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":220.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":183.44,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":201.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":210.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":184.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":183.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":192.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":183.44,"methodology":"fee schedule"}]}]},{"description":"Level 1 Minor Procedures ","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":27.41,"maximum":32.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":30.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30.15,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":30.15,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27.41,"methodology":"fee schedule"}]}]},{"description":"Level 1 Radiation Therapy ","code_information":[{"code":"5621","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":110.38,"maximum":132.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":113.14,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":118.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":117.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":121.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":118.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":121.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":112.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":118.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":110.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":110.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":132.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":110.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":121.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":126.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":110.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":110.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":115.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":110.38,"methodology":"fee schedule"}]}]},{"description":"Level 2 Airway Endoscopy ","code_information":[{"code":"5152","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":375.88,"maximum":451.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":385.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":402.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":398.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":383.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":383.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":413.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":402.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":413.47,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":383.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":402.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":375.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":375.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":451.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":375.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":413.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":432.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":377.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":375.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":394.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":375.88,"methodology":"fee schedule"}]}]},{"description":"Level 2 ENT Procedures ","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":506.49,"maximum":607.79,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":519.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":541.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":536.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":516.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":516.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":557.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":541.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":557.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":516.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":541.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":506.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":506.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":607.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":506.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":557.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":582.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":509.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":506.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":531.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":506.49,"methodology":"fee schedule"}]}]},{"description":"Level 2 Intraocular Proce ","code_information":[{"code":"5492","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3742.81,"maximum":4491.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3836.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4004.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3967.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3817.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3817.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4117.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4004.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4117.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3817.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4004.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3742.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3742.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4491.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3742.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4117.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4304.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3761.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3742.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3929.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3742.81,"methodology":"fee schedule"}]}]},{"description":"Level 2 Nuclear Medicine ","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":497.56,"maximum":597.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":510.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":532.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":527.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":507.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":507.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":547.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":532.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":547.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":507.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":532.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":597.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":547.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":572.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":500.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":497.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":522.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":497.56,"methodology":"fee schedule"}]}]},{"description":"Level 2 Urology and Relat ","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":628.83,"maximum":754.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":644.56,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":672.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":666.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":641.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":641.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":691.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":672.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":691.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":641.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":672.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":754.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":691.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":723.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":631.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":628.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":660.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":628.83,"methodology":"fee schedule"}]}]},{"description":"Level 3 Electrophysiologi ","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":21863.42,"maximum":26236.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22410.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23393.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23175.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22300.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22300.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24049.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23393.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24049.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22300.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23393.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26236.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24049.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25142.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21972.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21863.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22956.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21863.42,"methodology":"fee schedule"}]}]},{"description":"Level 3 Imaging without C ","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":225.57,"maximum":270.68,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":231.21,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":241.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":239.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":230.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":230.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":248.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":241.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":248.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":230.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":241.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":225.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":225.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":270.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":225.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":248.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":259.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":226.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":225.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":236.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":225.57,"methodology":"fee schedule"}]}]},{"description":"Level 3 Pacemaker and Sim ","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":9829.87,"maximum":11795.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10075.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10517.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10419.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10026.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10026.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10812.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10517.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10812.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10026.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10517.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9829.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9829.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11795.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9829.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10812.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11304.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9879.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9829.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10321.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9829.87,"methodology":"fee schedule"}]}]},{"description":"Level 4 Airway Endoscopy ","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3447.31,"maximum":4136.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3533.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3688.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3654.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3516.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3516.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3792.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3688.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3792.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3516.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3688.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4136.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3792.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3964.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3464.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3447.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3619.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3447.31,"methodology":"fee schedule"}]}]},{"description":"Level 4 Gynecologic Proce ","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2877.97,"maximum":3453.56,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2949.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3079.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3050.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2935.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2935.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3165.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3079.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3165.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2935.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3079.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2877.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2877.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3453.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2877.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3165.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3309.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2892.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2877.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3021.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2877.97,"methodology":"fee schedule"}]}]},{"description":"Level 4 Pathology ","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":791.57,"maximum":949.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":811.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":846.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":839.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":807.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":807.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":870.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":846.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":870.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":807.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":846.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":791.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":791.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":949.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":791.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":870.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":910.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":795.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":791.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":831.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":791.57,"methodology":"fee schedule"}]}]},{"description":"Level 5 Intraocular Proce ","code_information":[{"code":"5495","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":14529.52,"maximum":17435.42,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14892.76,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15546.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15401.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14820.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14820.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15982.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15546.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15982.47,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14820.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15546.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14529.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14529.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17435.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14529.52,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15982.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16708.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14602.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14529.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15256.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14529.52,"methodology":"fee schedule"}]}]},{"description":"Level 6 Intraocular Proce ","code_information":[{"code":"5496","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":15971.00,"maximum":19165.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16370.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17088.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16929.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16290.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16290.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17568.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17088.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17568.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16290.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17088.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15971.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15971.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19165.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15971.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17568.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18366.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16050.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15971.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16769.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15971.00,"methodology":"fee schedule"}]}]},{"description":"Lidocaine ","code_information":[{"code":"80176","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.32,"maximum":17.63,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) ","code_information":[{"code":"83701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.69,"maximum":40.63,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":34.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":32.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":37.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":38.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":34.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33.86,"methodology":"fee schedule"}]}]},{"description":"Lithium ","code_information":[{"code":"80178","type":"CPT"},{"code":"L000004201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.99,"maximum":7.93,"gross_charge":73.25,"discounted_cash":73.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.61,"methodology":"fee schedule"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WIT ","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":84801.16,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15473.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15850.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16001.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20150.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25602.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20150.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15246.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15246.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":29041.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":44664.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29041.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20150.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16605.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":84801.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":35107.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":84801.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16001.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":29001.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15397.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15850.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16152.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14643.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15850.75,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16001.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18869.94,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12823.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16605.55,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15850.75,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16681.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15397.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":30563.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14371.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15095.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16681.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14794.03,"methodology":"fee schedule"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC ","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":81044.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14825.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15187.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15331.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":46348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":42555.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11564.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14692.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11564.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14608.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14608.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16666.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":25631.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16666.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11564.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15910.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":81044.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":33552.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":81044.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15331.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":27716.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14753.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15187.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15476.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14030.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15187.19,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15331.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18079.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12255.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15910.39,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15187.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15982.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14753.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26128.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13769.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14463.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15982.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14174.71,"methodology":"fee schedule"}]}]},{"description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid l ","code_information":[{"code":"L0650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1204.15,"maximum":1489.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1272.42,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1328.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1315.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1266.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1266.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1365.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1328.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1365.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1266.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1328.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1241.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1241.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1204.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1489.67,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1241.39,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1365.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1427.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1247.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1241.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1303.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1241.39,"methodology":"fee schedule"}]}]},{"description":"Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis ","code_information":[{"code":"86353","type":"CPT"},{"code":"L000267301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":44.44,"maximum":58.84,"gross_charge":1334.50,"discounted_cash":1334.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":44.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":58.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":46.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":53.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":56.38,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":49.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":49.03,"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":1050.00,"maximum":94532.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17151.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17569.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17736.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21416.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":27210.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21416.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16900.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16900.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":30865.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":47469.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":30865.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21416.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18406.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":94532.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":39136.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":94532.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17736.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":32329.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17067.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17569.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17904.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16231.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17569.64,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17736.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20916.24,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14295.45,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18406.29,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17569.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18489.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17067.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15929.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16732.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18489.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16398.33,"methodology":"fee schedule"}]}]},{"description":"MAJOR BLADDER PROCEDURES WITH CC ","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":121293.73,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21765.73,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22296.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22508.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":37073.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":47104.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":37073.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21447.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21447.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":53430.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":82173.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":53430.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":37073.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23358.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":121293.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":50215.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":121293.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22508.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":41481.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21659.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22296.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22721.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20597.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22296.60,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":22508.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26543.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18342.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23358.35,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":22296.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23464.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21659.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20215.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21234.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23464.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20810.16,"methodology":"fee schedule"}]}]},{"description":"MAJOR CHEST TRAUMA WITHOUT CC/MCC ","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":33423.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6614.37,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6775.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6840.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6559.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8334.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6559.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6517.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6517.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9454.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14540.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9454.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6559.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7098.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":33423.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":13837.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":33423.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6840.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11430.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6582.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6775.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6904.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6259.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6775.69,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6840.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8066.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5054.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7098.34,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6775.69,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7130.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6582.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6143.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6453.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7130.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6323.98,"methodology":"fee schedule"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH MCC ","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":181775.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32194.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32979.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33293.79,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":31849.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":40465.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":31849.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31723.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31723.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":45900.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":70593.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":45900.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":31849.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34550.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":181775.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":75255.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":181775.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33293.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":62166.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":32037.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32979.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33607.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30466.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32979.70,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":33293.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":39261.55,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":27488.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34550.16,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":32979.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":34707.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32037.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29901.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31409.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34707.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30781.06,"methodology":"fee schedule"}]}]},{"description":"MAJOR MALE PELVIC PROCEDURES WITH CC/MCC ","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":77937.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":35592.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15233.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":35592.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":29005.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15604.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15753.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41712.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":38301.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19984.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25391.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19984.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15010.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15010.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28801.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":44295.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28801.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19984.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16347.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":77937.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":32268.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":77937.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15753.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28525.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15158.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15604.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15902.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14415.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15604.76,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15753.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18577.10,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12613.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16347.85,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15604.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16422.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15158.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":33980.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14148.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14861.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16422.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14564.45,"methodology":"fee schedule"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":70964.93,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":40622.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13087.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":40622.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":33105.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13406.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13534.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":23346.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":29663.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":23346.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12896.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12896.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":33647.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":51747.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":33647.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":23346.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14045.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":70964.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":29379.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":70964.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13534.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24269.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13023.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13406.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13662.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12385.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13406.80,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13534.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15960.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10731.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14045.22,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13406.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14109.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13023.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12155.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12768.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14109.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12513.01,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC ","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":77764.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14260.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14607.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14747.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9556.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12141.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9556.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14051.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14051.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13772.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21181.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13772.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9556.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15303.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":77764.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":32194.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":77764.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14747.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":26595.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14190.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14607.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14886.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13494.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14607.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14747.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17390.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11759.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15303.51,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14607.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15373.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14190.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13244.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13912.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15373.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13634.03,"methodology":"fee schedule"}]}]},{"description":"Manganese ","code_information":[{"code":"83785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.15,"maximum":31.98,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.32,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.65,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, caster fork, any size, replacement only, each ","code_information":[{"code":"E2226","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":49.16,"maximum":60.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":51.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":51.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":49.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":60.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":55.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.28,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":50.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.68,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, headrest extension, each ","code_information":[{"code":"E0966","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":86.57,"maximum":107.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":91.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":95.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":94.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":91.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":91.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":98.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":95.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":98.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":91.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":95.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":89.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":89.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":86.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":107.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":89.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":98.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":102.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":89.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":89.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":93.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":89.25,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, pneumatic propulsion tire, any size, each ","code_information":[{"code":"E2211","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":47.90,"maximum":59.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":52.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":50.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":50.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":52.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":50.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":52.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":47.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":59.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":54.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":49.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":49.38,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each ","code_information":[{"code":"E2212","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":7.70,"maximum":9.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.94,"methodology":"fee schedule"}]}]},{"description":"Mattress, innerspring ","code_information":[{"code":"E0271","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":185.11,"maximum":229.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":195.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":204.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":202.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":194.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":194.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":209.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":204.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":209.91,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":194.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":204.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":190.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":190.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":185.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":229.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":190.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":209.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":219.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":191.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":190.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":200.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":190.83,"methodology":"fee schedule"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) full gene analysis, including small sequence changes in exonic and intronic regions, deletions, duplications, mobile element insertions, and variants in non-unique ","code_information":[{"code":"0234U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":501.48,"maximum":633.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":541.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":564.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":559.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":538.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":538.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":580.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":564.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":580.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":538.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":564.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":633.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":501.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":580.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":607.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":530.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":554.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":527.87,"methodology":"fee schedule"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC ","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":42359.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8155.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8354.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8433.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6090.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7737.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6090.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8035.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8035.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8777.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":13498.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8777.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6090.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8751.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":42359.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":17536.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":42359.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8433.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14486.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8115.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8354.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8513.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7717.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8354.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8433.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9945.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6405.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8751.94,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8354.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8791.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8115.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7574.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7956.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8791.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7797.19,"methodology":"fee schedule"}]}]},{"description":"Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2) ","code_information":[{"code":"80436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":82.62,"maximum":109.39,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":93.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":97.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":100.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":97.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":100.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":92.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":97.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":82.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":109.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":86.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":100.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":104.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":91.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":95.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":91.16,"methodology":"fee schedule"}]}]},{"description":"MINOR BLADDER PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":46413.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8854.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9070.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9156.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9578.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12169.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9578.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8724.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8724.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13804.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21230.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13804.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9578.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9501.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46413.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19215.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":46413.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9156.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15873.06,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8810.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9070.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9242.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8379.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9070.08,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9156.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10797.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7018.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9501.99,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9070.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9545.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8810.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8223.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8638.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9545.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8465.41,"methodology":"fee schedule"}]}]},{"description":"Mitochondrial antibody (eg, M2), each ","code_information":[{"code":"86381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.07,"maximum":30.54,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":23.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25.45,"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":"81288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":182.70,"maximum":230.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":197.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":205.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":203.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":196.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":196.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":211.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":205.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":211.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":196.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":205.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":230.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":182.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":211.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":221.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":193.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":201.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":192.32,"methodology":"fee schedule"}]}]},{"description":"Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or 1 somatic variant ºtypically using nonsequencing target variant analysis», or detection of a dynamic mutation disorder/t ","code_information":[{"code":"81401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"Mometasone sinus sinuva ","code_information":[{"code":"9346","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":11.35,"maximum":13.61,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.35,"methodology":"fee schedule"}]}]},{"description":"MRI and MRA with Contrast ","code_information":[{"code":"8008","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":803.31,"maximum":963.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":823.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":859.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":851.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":819.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":819.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":883.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":859.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":883.65,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":819.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":859.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":803.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":803.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":963.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":803.31,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":883.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":923.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":807.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":803.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":843.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":803.31,"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":292.60,"maximum":369.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":315.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":329.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":326.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":314.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":314.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":338.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":329.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":338.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":314.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":329.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":369.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":292.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":338.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":354.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":309.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":323.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":308.00,"methodology":"fee schedule"}]}]},{"description":"MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WIT ","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":450530.61,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":48145.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":78535.73,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":48145.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":39236.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":80451.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":81217.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":116146.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":147570.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":116146.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":77386.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":77386.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":167391.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":257438.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":167391.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":116146.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":84282.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":450530.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":186520.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":450530.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":81217.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":154079.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":78152.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":80451.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":81983.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":74321.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":80451.23,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":81217.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":95775.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":68130.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":84282.24,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":80451.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":84665.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":78152.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":227404.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":72942.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":76620.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":84665.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":75087.82,"methodology":"fee schedule"}]}]},{"description":"Multipositional patient support system, with integrated lift, patient accessible controls ","code_information":[{"code":"E0636","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":1316.70,"maximum":1628.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1391.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1452.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1438.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1384.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1384.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1493.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1452.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1493.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1384.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1452.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1357.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1357.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1316.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1628.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1357.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1493.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1561.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1364.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1357.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1425.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1357.42,"methodology":"fee schedule"}]}]},{"description":"Myeloperoxidase (MPO) ","code_information":[{"code":"83876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46.09,"maximum":61.03,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":52.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":51.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":46.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":48.32,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":55.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.86,"methodology":"fee schedule"}]}]},{"description":"Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap ","code_information":[{"code":"A7034","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":102.66,"maximum":127.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":108.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":113.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":112.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":107.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":107.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":116.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":113.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":116.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":107.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":113.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":105.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":105.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":102.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":127.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":105.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":116.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":121.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":106.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":105.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":111.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":105.83,"methodology":"fee schedule"}]}]},{"description":"Nebulizer, with compressor ","code_information":[{"code":"E0570","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":14.28,"maximum":17.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.72,"methodology":"fee schedule"}]}]},{"description":"Nephelometry, each analyte not elsewhere specified ","code_information":[{"code":"83883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.33,"maximum":16.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.60,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid tumor), DNA (80 genes) & RNA (36 genes), by next-generation sequencing from plasma, including single nucleotide variants, insertions, deletions, copy number alterations, microsatellite ","code_information":[{"code":"0409U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2773.62,"maximum":3503.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2992.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3094.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3503.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2773.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3357.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2934.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3065.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"}]}]},{"description":"Oncology (thyroid), mutation analysis of 10 genes and 37 RNA fusions and expression of 4 mRNA markers using next-generation sequencing, fine needle aspirate, report includes associated risk of maligna ","code_information":[{"code":"0245U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1202.77,"maximum":1519.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1297.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1354.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1342.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1291.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1291.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1392.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1354.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1392.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1291.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1354.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1519.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1202.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1392.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1455.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1272.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1266.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1329.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1266.07,"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":901.07,"maximum":1138.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":972.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1014.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1005.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":967.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":967.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1043.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1014.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1043.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":967.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1014.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1138.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":901.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1043.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1090.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":953.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":995.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":948.50,"methodology":"fee schedule"}]}]},{"description":"Oncoprotein; HER-2/neu ","code_information":[{"code":"83950","type":"CPT"},{"code":"L000172301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":58.37,"maximum":77.29,"gross_charge":1748.75,"discounted_cash":1748.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":58.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":61.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":74.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"}]}]},{"description":"ORBITAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":50810.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9612.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9846.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9940.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7409.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9414.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7409.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9471.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9471.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10679.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16423.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10679.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7409.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10315.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":50810.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21035.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":50810.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9940.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17376.87,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9565.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9846.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10034.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9096.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9846.77,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9940.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11722.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7683.65,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10315.67,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9846.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10362.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9565.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8927.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9377.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10362.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9190.32,"methodology":"fee schedule"}]}]},{"description":"Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minu ","code_information":[{"code":"97760","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":39.03,"maximum":46.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":40.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":39.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":39.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":39.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":40.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39.03,"methodology":"fee schedule"}]}]},{"description":"Osteocalcin (bone g1a protein) ","code_information":[{"code":"83937","type":"CPT"},{"code":"L000172101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":27.05,"maximum":35.82,"gross_charge":567.00,"discounted_cash":567.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":27.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":28.36,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29.85,"methodology":"fee schedule"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC ","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":49469.13,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9381.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9609.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9701.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":3840.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":4879.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":3840.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9243.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9243.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":5535.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":8512.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":5535.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":3840.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10067.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49469.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20480.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49469.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9701.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16918.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9335.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9609.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9792.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8877.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9609.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9701.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11440.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7480.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10067.51,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9609.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10113.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9335.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8712.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9152.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10113.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8969.23,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC ","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":40459.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7827.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8018.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8094.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10170.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12921.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10170.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7713.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7713.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14657.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22542.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14657.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10170.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8400.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":40459.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16750.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40459.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8094.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13837.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7789.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8018.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8171.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7407.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8018.55,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8094.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9545.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6118.45,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8400.38,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8018.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8438.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7789.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7270.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7636.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8438.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7483.98,"methodology":"fee schedule"}]}]},{"description":"OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":33926.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6701.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6864.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6929.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8181.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10394.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8181.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6603.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6603.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11790.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18133.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11790.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8181.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7191.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":33926.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14045.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":33926.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6929.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11602.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6668.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6864.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6995.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6341.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6864.52,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6929.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8172.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5130.45,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7191.40,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6864.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7224.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6668.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6223.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6537.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7224.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6406.89,"methodology":"fee schedule"}]}]},{"description":"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":50921.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9631.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9866.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9960.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":34533.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":31709.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8551.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10864.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8551.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9490.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9490.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12324.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18953.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12324.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8551.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10336.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":50921.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21081.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":50921.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9960.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17415.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9584.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9866.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10054.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9114.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9866.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9960.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11745.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7700.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10336.35,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9866.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10383.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9584.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8945.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9396.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10383.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9208.74,"methodology":"fee schedule"}]}]},{"description":"OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":55426.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10408.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10662.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10763.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21148.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26869.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21148.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10256.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10256.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":30478.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":46874.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":30478.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21148.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11169.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":55426.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22946.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":55426.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10763.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18955.65,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10357.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10662.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10865.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9849.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10662.18,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10763.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12693.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8381.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11169.91,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10662.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11220.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10357.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9667.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10154.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11220.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9951.37,"methodology":"fee schedule"}]}]},{"description":"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC ","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":72606.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13370.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13696.82,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13827.27,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8974.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11402.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8974.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13175.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13175.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12934.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19891.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12934.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8974.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14349.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":72606.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":30059.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":72606.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13827.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24831.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13305.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13696.82,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13957.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12653.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13696.82,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13827.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16305.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10979.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14349.05,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13696.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14414.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13305.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12418.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13044.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14414.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12783.70,"methodology":"fee schedule"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC ","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173955.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":66863.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26379.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":66863.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":54491.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27022.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27280.16,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":86310.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":79250.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":36698.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46626.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":36698.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25993.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25993.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":52889.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":81341.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":52889.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":36698.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28309.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72021.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27280.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":50632.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":26250.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27022.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27537.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24963.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27022.80,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":27280.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32170.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22388.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28309.60,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":27022.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28438.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26250.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":57042.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24500.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25736.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28438.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25221.28,"methodology":"fee schedule"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC ","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":61001.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11369.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11646.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11757.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12426.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15788.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12426.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11203.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11203.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17908.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27542.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17908.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12426.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12201.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":61001.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":25254.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":61001.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11757.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":20862.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11314.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11646.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11868.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10759.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11646.90,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11757.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13865.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9224.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12201.52,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11646.90,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12256.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11314.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10559.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11092.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12256.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10870.44,"methodology":"fee schedule"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC ","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":86464.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15760.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16144.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16298.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":38358.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":35221.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15393.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19558.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15393.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15529.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15529.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22185.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34120.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22185.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15393.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16913.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":86464.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":35796.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":86464.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16298.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":29570.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15683.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16144.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16452.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14914.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16144.57,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16298.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19219.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13075.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16913.36,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16144.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16990.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15683.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":37008.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14637.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15375.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16990.24,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15068.26,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC ","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":54511.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10250.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10500.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10600.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16445.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20894.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16445.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10100.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10100.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":23701.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":36450.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":23701.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16445.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11000.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":54511.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22567.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":54511.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10600.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18642.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10200.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10500.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10700.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9700.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10500.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10600.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12500.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8243.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11000.50,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10500.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11050.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10200.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9520.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10000.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11050.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9800.44,"methodology":"fee schedule"}]}]},{"description":"OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC ","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":38934.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7564.52,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7749.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7822.82,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7580.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9631.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7580.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7453.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7453.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10925.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16802.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10925.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7580.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8118.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":38934.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16118.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38934.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7822.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13315.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7527.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7749.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7896.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7158.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7749.02,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7822.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9225.03,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5887.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8118.02,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7749.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8154.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7527.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7025.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7380.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8154.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7232.42,"methodology":"fee schedule"}]}]},{"description":"OTHER VASCULAR PROCEDURES WITH MCC ","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":76033.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":30634.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26274.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":30634.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":24965.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26914.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27171.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":34303.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":43584.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":34303.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25889.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25889.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":49438.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":76033.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":49438.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":34303.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28196.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52886.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21896.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52886.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27171.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":50423.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":26145.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26914.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27427.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24864.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26914.99,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":27171.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32041.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22296.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28196.65,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":26914.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28324.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26145.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":56644.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24402.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25633.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28324.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25120.65,"methodology":"fee schedule"}]}]},{"description":"Oxygen and water vapor enriching system with heated delivery ","code_information":[{"code":"E1405","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":204.13,"maximum":252.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":215.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":225.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":223.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":231.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":225.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":231.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":214.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":225.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":210.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":210.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":204.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":252.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":210.44,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":231.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":242.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":211.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":210.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":220.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":210.44,"methodology":"fee schedule"}]}]},{"description":"Pain management (opioid-use disorder) genotyping panel, 16 common variants (ie, ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), buccal swab or othe ","code_information":[{"code":"0078U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":428.36,"maximum":541.09,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":462.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":477.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":482.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":541.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":428.36,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":496.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":518.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":453.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":473.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"}]}]},{"description":"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC ","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":120704.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21664.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22192.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22403.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":49424.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":62796.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":49424.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21347.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21347.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":71230.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":109549.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":71230.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":49424.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23249.38,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":120704.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":49971.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":120704.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22403.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":41280.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21558.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22192.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22615.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20501.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22192.59,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":22403.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26419.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18253.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23249.38,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":22192.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":23355.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21558.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20121.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21135.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23355.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20713.08,"methodology":"fee schedule"}]}]},{"description":"Partial Hospitalization ( ","code_information":[{"code":"5863","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":250.36,"maximum":300.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":256.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":265.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":255.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":267.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":300.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":275.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":287.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":251.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":250.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":262.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":250.36,"methodology":"fee schedule"}]}]},{"description":"PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH ","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":32482.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6452.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6609.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6672.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10269.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13048.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10269.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6357.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6357.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14801.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22763.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14801.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10269.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6924.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":32482.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":13447.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":32482.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6672.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11108.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6420.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6609.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6735.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6105.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6609.42,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6672.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7868.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4912.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6924.16,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6609.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6955.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6420.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5992.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6294.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6955.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6168.79,"methodology":"fee schedule"}]}]},{"description":"Pediatrics (congenital epigenetic disorders), whole genome methylation analysis by microarray for 50 or more genes, blood ","code_information":[{"code":"0318U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1681.96,"maximum":2124.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1814.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1894.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1876.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1805.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1805.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1947.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1894.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1947.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1805.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1894.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2124.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1681.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1947.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2036.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1779.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1770.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1859.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1770.48,"methodology":"fee schedule"}]}]},{"description":"Penicillin g procaine inj ","code_information":[{"code":"1836","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":40.94,"maximum":49.13,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":43.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":45.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":45.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":49.13,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":45.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":47.08,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":41.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":40.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":42.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":40.94,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC ","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":56211.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":36984.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17991.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":36984.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":30141.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18430.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18606.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41567.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":38165.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":23918.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17728.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17728.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27131.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41726.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27131.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19308.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48731.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20176.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48731.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18606.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":33996.69,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17904.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18430.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18781.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17026.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18430.61,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":18606.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21941.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15032.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19308.26,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18430.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19396.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17904.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":56211.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16710.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17552.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19396.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17201.90,"methodology":"fee schedule"}]}]},{"description":"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC ","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":72487.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":41612.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":28805.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":41612.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":33912.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29508.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":29789.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15364.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19521.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15364.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":28384.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":28384.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22144.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34056.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22144.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15364.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":30913.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28810.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29789.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":55445.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":28665.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29508.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30070.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27260.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29508.52,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":29789.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35129.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":24516.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":30913.69,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":29508.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":31054.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":28665.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":72487.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26754.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28103.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31054.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27541.28,"methodology":"fee schedule"}]}]},{"description":"Pertuzu, trastuzu, 10 mg ","code_information":[{"code":"9390","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":64.58,"maximum":77.49,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":66.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":69.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":69.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":69.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":77.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":74.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":64.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":64.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":67.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64.58,"methodology":"fee schedule"}]}]},{"description":"Phenytoin; total ","code_information":[{"code":"80185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.01,"maximum":15.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"Perfluroalkyl substances, 16 PFAS compounds by liquid chromatography with tandem mass spectrometry, plasma or serum, quantitative ","code_information":[{"code":"0394U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":188.80,"maximum":238.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":212.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":210.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":202.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":202.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":218.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":212.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":218.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":202.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":212.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":238.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":188.80,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":218.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":228.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":199.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":198.74,"methodology":"fee schedule"}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITH CC ","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":90797.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16507.26,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16909.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17070.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25958.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":32981.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25958.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16265.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16265.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":37411.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":57536.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":37411.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25958.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17715.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":90797.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37590.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":90797.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17070.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31052.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16426.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16909.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17231.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15621.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16909.87,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17070.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20130.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13730.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17715.10,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16909.87,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17795.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16426.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15331.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16104.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17795.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15782.55,"methodology":"fee schedule"}]}]},{"description":"pH; exhaled breath condensate ","code_information":[{"code":"83987","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.40,"maximum":4.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.58,"methodology":"fee schedule"}]}]},{"description":"Phosphatase, acid; total ","code_information":[{"code":"84060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.93,"maximum":9.17,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.64,"methodology":"fee schedule"}]}]},{"description":"Phospholipid neutralization; platelet ","code_information":[{"code":"85597","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.30,"maximum":21.58,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.08,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"}]}]},{"description":"Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using st ","code_information":[{"code":"97161","type":"CPT"},{"code":"T000061001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":95.03,"maximum":117.55,"gross_charge":351.75,"discounted_cash":351.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":100.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":104.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":103.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":99.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":99.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":107.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":104.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":107.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":99.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":104.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":97.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":97.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":95.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":117.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":97.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":107.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":112.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":98.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":97.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":102.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":97.96,"methodology":"fee schedule"}]}]},{"description":"Pinworm exam (eg, cellophane tape prep) ","code_information":[{"code":"87172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.87,"maximum":5.12,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"Plasmaprotein fract,5%,25 ","code_information":[{"code":"9519","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":102.04,"maximum":122.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":104.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":108.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":104.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":104.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":104.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":102.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":102.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":122.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":102.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":112.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":117.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":102.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":102.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":107.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":102.04,"methodology":"fee schedule"}]}]},{"description":"Platelets, each unit ","code_information":[{"code":"9515","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":65.04,"maximum":78.05,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":66.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":66.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":71.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":74.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":65.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":65.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":68.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":65.04,"methodology":"fee schedule"}]}]},{"description":"PLEURAL EFFUSION WITH MCC ","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":67913.14,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12561.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12867.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12990.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12406.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15762.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12406.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12377.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12377.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17880.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27498.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17880.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12406.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13480.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":67913.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28116.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":67913.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12990.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":23226.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12500.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12867.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13112.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11887.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12867.74,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12990.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15318.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10270.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13480.49,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12867.74,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13541.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12500.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11666.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12254.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13541.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12009.89,"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":731.10,"maximum":923.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":788.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":823.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":815.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":784.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":784.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":846.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":823.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":846.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":784.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":823.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":923.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":731.10,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":846.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":885.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":773.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":808.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":769.58,"methodology":"fee schedule"}]}]},{"description":"PNEUMOTHORAX WITH MCC ","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75873.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13933.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14273.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14409.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14454.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18364.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14454.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13730.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13730.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":20831.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":32037.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20831.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14454.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14953.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":75873.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31411.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":75873.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14409.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25948.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13866.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14273.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14545.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13186.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14273.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14409.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16992.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11473.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14953.54,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14273.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15021.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13866.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12941.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13594.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15021.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13322.25,"methodology":"fee schedule"}]}]},{"description":"Porphyrins, urine; qualitative ","code_information":[{"code":"84119","type":"CPT"},{"code":"L000175801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.11,"maximum":16.03,"gross_charge":237.75,"discounted_cash":237.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.36,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.36,"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":68.45,"maximum":84.68,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":72.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":74.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":71.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":71.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":77.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":77.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":71.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":75.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":70.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":70.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":68.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":84.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":70.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":77.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":81.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":70.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":70.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":74.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":70.57,"methodology":"fee schedule"}]}]},{"description":"Positioning wheelchair back cushion, posterior-lateral, width less than 22 inches, any height, including any type mounting hardware ","code_information":[{"code":"E2615","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":474.43,"maximum":586.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":501.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":523.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":518.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":498.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":498.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":538.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":523.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":538.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":498.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":523.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":489.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":489.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":474.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":586.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":489.10,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":538.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":562.47,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":491.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":489.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":513.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":489.10,"methodology":"fee schedule"}]}]},{"description":"POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":81756.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10400.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10653.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10755.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":36885.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46864.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":36885.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10247.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10247.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":53159.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":81756.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":53159.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":36885.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11161.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":55379.30,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22927.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":55379.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10755.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18939.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10349.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10653.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10856.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9842.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10653.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10755.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12683.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8374.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11161.16,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10653.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11211.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10349.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9659.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10146.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11211.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9943.58,"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":2596.16,"maximum":3211.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2743.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2863.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2837.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2729.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2729.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2944.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2863.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2944.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2729.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2863.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2676.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2676.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2596.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3211.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2676.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2944.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3077.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2689.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2676.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2810.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2676.45,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, breath tube kit for sip and puff interface ","code_information":[{"code":"E2326","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":39.61,"maximum":49.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.86,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":43.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":41.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":44.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":46.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":41.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":40.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":42.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":40.84,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only ","code_information":[{"code":"E2376","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":147.79,"maximum":182.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":156.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":163.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":161.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":155.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":155.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":167.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":163.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":167.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":155.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":163.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":152.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":152.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":147.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":182.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":152.36,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":167.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":175.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":153.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":152.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":159.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":152.36,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, absorbed glassmat), each ","code_information":[{"code":"E2371","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":171.74,"maximum":212.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":181.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":189.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":187.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":180.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":180.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":194.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":189.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":194.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":180.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":189.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":177.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":177.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":171.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":212.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":177.05,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":194.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":203.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":177.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":177.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":177.05,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, head control interface, proximity switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head arr ","code_information":[{"code":"E2330","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":390.36,"maximum":482.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":412.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":430.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":426.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":410.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":410.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":442.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":430.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":442.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":410.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":430.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":390.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":482.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":442.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":462.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":404.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":422.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":402.43,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any size, replacement only, each ","code_information":[{"code":"E2391","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":22.51,"maximum":27.85,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":23.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":25.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.21,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair component, actuator, replacement only ","code_information":[{"code":"E2378","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":67.45,"maximum":83.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":74.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":76.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":74.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":76.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":70.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":74.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":67.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":83.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":76.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":79.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":69.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":73.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":69.54,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601 pounds or more ","code_information":[{"code":"K0829","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":1085.49,"maximum":1342.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1147.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1197.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1186.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1141.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1141.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1230.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1197.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1230.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1141.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1197.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1119.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1119.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1085.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1342.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1119.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1230.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1286.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1124.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1119.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1175.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1119.06,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds ","code_information":[{"code":"K0823","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":517.29,"maximum":639.95,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":546.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":570.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":565.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":543.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":543.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":586.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":570.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":586.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":543.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":570.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":533.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":533.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":517.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":639.95,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":533.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":586.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":613.28,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":535.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":533.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":559.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":533.29,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 2 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds ","code_information":[{"code":"K0827","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":850.60,"maximum":1052.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":898.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":938.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":929.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":894.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":894.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":964.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":938.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":964.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":894.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":938.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":876.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":876.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":850.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1052.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":876.91,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":964.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1008.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":881.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":876.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":920.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":876.91,"methodology":"fee schedule"}]}]},{"description":"PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"PREMATURITY WITHOUT MAJOR PROBLEMS ","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":23180.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":1454.00,"methodology":"per diem"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19007.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":1454.00,"methodology":"per diem"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19471.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19656.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6319.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8029.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6319.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18729.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18729.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9107.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14007.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9107.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6319.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20398.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19656.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18915.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19471.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19842.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17987.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19471.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19656.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23180.38,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20398.73,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19471.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20491.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18915.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4245.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17654.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18544.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20491.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18173.41,"methodology":"fee schedule"}]}]},{"description":"PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS ","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":790.55,"maximum":24561.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":851.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1275.00,"methodology":"per diem"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11081.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14079.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11081.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":838.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":838.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15970.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24561.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15970.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11081.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":913.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":880.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":847.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":888.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":805.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":871.93,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":880.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1038.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":913.45,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":871.93,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":917.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":847.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":790.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":830.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":917.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":813.80,"methodology":"fee schedule"}]}]},{"description":"Prostaglandin, each ","code_information":[{"code":"84150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37.86,"maximum":50.12,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":42.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":44.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":44.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":42.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":42.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":44.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":42.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":44.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":37.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":50.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":39.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":45.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":41.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":43.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":41.77,"methodology":"fee schedule"}]}]},{"description":"Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes ","code_information":[{"code":"97761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39.08,"maximum":48.35,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":42.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":41.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":41.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":44.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":44.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":41.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":39.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":48.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":44.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":46.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":40.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":40.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":42.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":40.29,"methodology":"fee schedule"}]}]},{"description":"Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) ","code_information":[{"code":"84166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.16,"maximum":21.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.83,"methodology":"fee schedule"}]}]},{"description":"Protoporphyrin, RBC; screen ","code_information":[{"code":"84203","type":"CPT"},{"code":"L000183201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.83,"maximum":11.69,"gross_charge":214.75,"discounted_cash":214.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.74,"methodology":"fee schedule"}]}]},{"description":"PSYCHOSES ","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":26427.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11297.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11573.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11683.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11923.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15149.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11923.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11132.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11132.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17183.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26427.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17183.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11923.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12124.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11683.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11242.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11573.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11793.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10691.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11573.26,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11683.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13777.69,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9161.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12124.36,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11573.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12179.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11242.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10493.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11022.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12179.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10801.71,"methodology":"fee schedule"}]}]},{"description":"PULMONARY EMBOLISM WITHOUT MCC ","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":36345.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6887.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7055.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7123.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16397.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20834.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16397.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6787.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6787.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":23632.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":36345.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":23632.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16397.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7391.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35009.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14494.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35009.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7123.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11973.15,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6854.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7055.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7190.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6518.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7055.85,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7123.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8399.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5294.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7391.84,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7055.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7425.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6854.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6397.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6719.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7425.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6585.46,"methodology":"fee schedule"}]}]},{"description":"Quinine ","code_information":[{"code":"84228","type":"CPT"},{"code":"L000183701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":10.54,"maximum":13.96,"gross_charge":163.00,"discounted_cash":163.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.05,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.37,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.63,"methodology":"fee schedule"}]}]},{"description":"Radiation treatment deliv ","code_information":[{"code":"4004","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":116.65,"maximum":139.99,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":119.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":124.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":123.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":118.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":118.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":124.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":118.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":124.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":116.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":116.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":139.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":116.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":128.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":134.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":116.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":122.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":116.65,"methodology":"fee schedule"}]}]},{"description":"Radiation treatment deliv ","code_information":[{"code":"4012","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":212.06,"maximum":254.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":217.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":226.91,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":224.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":216.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":216.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":233.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":226.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":233.27,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":216.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":226.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":212.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":212.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":254.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":212.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":233.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":243.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":213.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":212.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":222.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":212.06,"methodology":"fee schedule"}]}]},{"description":"Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side ","code_information":[{"code":"95852","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.78,"maximum":20.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.88,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.29,"methodology":"fee schedule"}]}]},{"description":"Rare DS Whl Gen & Mitochdrl DNA Seq Alys Ea Cmprtr ","code_information":[{"code":"0213U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2574.45,"maximum":3251.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2777.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2899.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2872.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2764.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2764.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2980.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2899.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2980.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2764.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2899.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2709.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2709.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3251.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2709.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2574.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2980.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3116.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2723.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2709.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2845.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2709.95,"methodology":"fee schedule"}]}]},{"description":"RBC leukocytes reduced ","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":180.82,"maximum":216.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":185.34,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":193.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":191.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":184.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":184.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":198.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":193.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":198.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":184.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":193.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":180.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":180.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":216.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":180.82,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":198.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":207.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":181.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":180.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":189.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":180.82,"methodology":"fee schedule"}]}]},{"description":"Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each ","code_information":[{"code":"K0070","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":21.88,"maximum":27.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.12,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":23.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":21.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.56,"methodology":"fee schedule"}]}]},{"description":"RECTAL RESECTION WITHOUT CC/MCC ","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":71283.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13142.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13462.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13591.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25192.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":32008.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25192.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12950.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12950.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36307.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":55839.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36307.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25192.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14104.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":71283.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":29511.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":71283.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13591.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24378.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13078.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13462.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13719.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12437.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13462.97,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13591.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16027.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10779.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14104.07,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13462.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14168.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13078.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12206.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12821.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14168.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12565.44,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (ABO blood group) genotyping (ABO), gene analysis Sanger/chain termination/conventional sequencing, ABO gene, including subtyping, 7 exons ","code_information":[{"code":"0180U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261.09,"maximum":329.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":281.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":261.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"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":175.94,"maximum":222.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":196.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":175.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":212.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":185.20,"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":261.09,"maximum":329.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":281.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":261.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"}]}]},{"description":"Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskelet ","code_information":[{"code":"98977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44.61,"maximum":53.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":45.73,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":45.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":45.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":45.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":47.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":49.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":51.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":44.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":44.61,"methodology":"fee schedule"}]}]},{"description":"Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus i ","code_information":[{"code":"80069","type":"CPT"},{"code":"L000001101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.87,"maximum":10.42,"gross_charge":632.75,"discounted_cash":632.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.68,"methodology":"fee schedule"}]}]},{"description":"Replacement cover for wheelchair seat cushion or back cushion, each ","code_information":[{"code":"E2619","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":57.37,"maximum":70.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":60.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":62.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":65.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":65.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":63.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":70.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":65.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":68.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":59.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":59.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":62.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":59.14,"methodology":"fee schedule"}]}]},{"description":"Thiotepa injection ","code_information":[{"code":"851","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":209.02,"maximum":250.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":214.24,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":223.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":221.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":213.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":213.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":229.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":223.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":229.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":213.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":223.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":209.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":209.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":250.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":209.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":229.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":240.37,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":210.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":209.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":219.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":209.02,"methodology":"fee schedule"}]}]},{"description":"Thymol turbidity, blood ","code_information":[{"code":"P2033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.69,"maximum":5.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"}]}]},{"description":"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":54450.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10240.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10489.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10589.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9486.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12053.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9486.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10090.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10090.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13671.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21026.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13671.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9486.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10989.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":54450.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22542.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":54450.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10589.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18621.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10190.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10489.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10689.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9690.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10489.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10589.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12487.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8234.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10989.35,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10489.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11039.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10190.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9510.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9990.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11039.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9790.52,"methodology":"fee schedule"}]}]},{"description":"Tiagabine ","code_information":[{"code":"80199","type":"CPT"},{"code":"L000006201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.57,"maximum":32.53,"gross_charge":374.25,"discounted_cash":374.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27.11,"methodology":"fee schedule"}]}]},{"description":"Tissue culture for non-neoplastic disorders; lymphocyte ","code_information":[{"code":"88230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105.58,"maximum":139.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":119.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":123.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":118.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":118.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":128.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":128.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":118.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":105.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":139.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":110.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":128.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":133.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":117.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":116.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":122.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":116.49,"methodology":"fee schedule"}]}]},{"description":"Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided ","code_information":[{"code":"L0469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":451.45,"maximum":558.49,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":477.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":497.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":493.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":474.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":474.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":511.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":497.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":511.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":474.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":497.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":465.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":465.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":451.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":558.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":465.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":511.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":535.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":467.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":465.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":488.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":465.41,"methodology":"fee schedule"}]}]},{"description":"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence ","code_information":[{"code":"81351","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":609.76,"maximum":770.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":657.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":686.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":680.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":654.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":654.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":706.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":686.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":706.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":654.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":686.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":641.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":641.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":770.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":641.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":609.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":706.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":738.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":645.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":641.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":673.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":641.85,"methodology":"fee schedule"}]}]},{"description":"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NEC ","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":607311.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":105569.26,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":108144.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 23. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":109174.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 23. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":133288.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":169350.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":133288.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":104024.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":104024.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":192096.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":295434.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":192096.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":133288.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":113293.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":607311.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":251427.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":607311.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":109174.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 24+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":207697.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":105054.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":108144.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 23. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":110204.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":99904.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":108144.12,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":109174.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":128743.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":113293.84,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":108144.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":113808.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":105054.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":98050.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":102994.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":113808.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":100934.51,"methodology":"fee schedule"}]}]},{"description":"Transferrin ","code_information":[{"code":"84466","type":"CPT"},{"code":"L000191601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.56,"maximum":15.31,"gross_charge":133.50,"discounted_cash":133.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.76,"methodology":"fee schedule"}]}]},{"description":"Transport chair, pediatric size ","code_information":[{"code":"E1037","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":137.96,"maximum":170.68,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":145.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":152.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":150.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":145.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":145.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":156.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":152.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":156.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":145.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":152.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":142.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":142.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":137.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":170.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":142.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":156.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":163.56,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":142.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":142.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":149.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":142.23,"methodology":"fee schedule"}]}]},{"description":"Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar ","code_information":[{"code":"E0912","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":116.45,"maximum":144.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":123.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":128.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":127.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":122.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":122.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":132.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":128.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":132.06,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":122.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":128.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":120.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":120.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":116.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":144.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":120.05,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":132.06,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":138.06,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":120.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":120.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":126.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":120.05,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC ","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":56376.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10572.12,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10829.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10933.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10440.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13265.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10440.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10417.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10417.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15046.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":23141.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15046.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10440.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11345.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":56376.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23339.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":56376.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10933.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19280.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10520.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10829.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11036.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10004.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10829.97,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10933.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12892.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8525.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11345.69,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10829.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11397.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10520.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9819.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10314.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11397.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10107.97,"methodology":"fee schedule"}]}]},{"description":"Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals ","code_information":[{"code":"92508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.97,"maximum":28.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.68,"methodology":"fee schedule"}]}]},{"description":"Triiodothyronine T3; total (TT-3) ","code_information":[{"code":"84480","type":"CPT"},{"code":"L000192001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.85,"maximum":17.02,"gross_charge":136.50,"discounted_cash":136.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.47,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.18,"methodology":"fee schedule"}]}]},{"description":"Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension ","code_information":[{"code":"86481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90.64,"maximum":120.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":102.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":106.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":102.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":102.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":110.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":110.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":102.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":107.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":100.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":100.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":90.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":100.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":95.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":110.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":115.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":100.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":100.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":105.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":100.00,"methodology":"fee schedule"}]}]},{"description":"UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, drug metabolism, hereditary unconjugated hyperbilirubinemia ºGilbert syndrome») gene analysis, common variants (eg, *28, *36, *37) ","code_information":[{"code":"81350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":222.30,"maximum":280.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":239.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":250.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":248.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":238.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":238.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":257.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":250.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":257.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":238.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":250.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":234.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":234.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":280.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":234.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":222.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":257.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":269.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":235.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":234.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":245.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":234.00,"methodology":"fee schedule"}]}]},{"description":"UNGROUPABLE ","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":790.55,"maximum":24561.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":851.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1275.00,"methodology":"per diem"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11081.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14079.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11081.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":838.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":838.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15970.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24561.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15970.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11081.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":913.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":880.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":847.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":888.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":805.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":871.93,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":880.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1038.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":913.45,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":871.93,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":917.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":847.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":790.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":830.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":917.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":813.80,"methodology":"fee schedule"}]}]},{"description":"Urea nitrogen; quantitative ","code_information":[{"code":"84520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.58,"maximum":4.74,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.95,"methodology":"fee schedule"}]}]},{"description":"Urinal; male, jug-type, any material ","code_information":[{"code":"E0325","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":11.62,"maximum":14.38,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"Urinalysis; qualitative or semiquantitative, except immunoassays ","code_information":[{"code":"81005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1.97,"maximum":2.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.17,"methodology":"fee schedule"}]}]},{"description":"Ustekinumab sub cu inj, 1 ","code_information":[{"code":"9261","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":159.91,"maximum":191.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":163.91,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":171.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":169.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":163.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":163.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":175.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":171.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":175.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":163.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":171.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":159.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":159.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":191.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":159.91,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":175.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":183.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":160.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":159.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":167.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":159.91,"methodology":"fee schedule"}]}]},{"description":"UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC ","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":169236.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30032.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30765.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31058.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":23384.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":29710.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":23384.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29593.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29593.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":33701.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":51831.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":33701.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":23384.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32230.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":169236.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":70064.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":169236.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31058.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":57878.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29886.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30765.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31351.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28421.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30765.04,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":31058.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36625.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25592.45,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":32230.04,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":30765.04,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":32376.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29886.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27893.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29300.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32376.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28714.04,"methodology":"fee schedule"}]}]},{"description":"VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC ","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":30619.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":11420.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8027.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":11420.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":9306.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8222.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8301.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":19540.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":17942.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6217.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7899.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6217.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7909.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7909.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8960.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":13781.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8960.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6217.55,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8614.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":30619.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12677.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":30619.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8301.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9133.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7987.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8222.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8379.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7596.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8222.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":8916.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8301.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9789.03,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5140.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8614.34,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8222.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8653.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":7389.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7987.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7455.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7831.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8653.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7674.60,"methodology":"fee schedule"}]}]},{"description":"Vanillylmandelic acid (VMA), urine ","code_information":[{"code":"84585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.05,"maximum":18.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.50,"methodology":"fee schedule"}]}]},{"description":"Ventilation Initiation an ","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":576.87,"maximum":692.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":591.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":617.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":611.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":588.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":588.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":634.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":617.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":634.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":588.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":617.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":576.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":576.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":692.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":576.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":634.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":663.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":579.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":576.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":605.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":576.87,"methodology":"fee schedule"}]}]},{"description":"VIRAL ILLNESS WITHOUT MCC ","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":38027.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7408.14,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7588.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7661.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6285.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7985.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6285.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7299.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7299.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9058.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":13931.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9058.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6285.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7950.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":38027.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":15743.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38027.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7661.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13005.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7372.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7588.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7733.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7010.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7588.83,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7661.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9034.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5750.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7950.20,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7588.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7986.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7372.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6880.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7227.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7986.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7082.90,"methodology":"fee schedule"}]}]},{"description":"Viscosity ","code_information":[{"code":"85810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.57,"maximum":14.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.67,"methodology":"fee schedule"}]}]},{"description":"VKORC1 (vitamin K epoxide reductase complex, subunit 1) (eg, warfarin metabolism), gene analysis, common variant(s) (eg, -1639G>A, c.173+1000C>T) ","code_information":[{"code":"81355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83.79,"maximum":105.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":90.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":94.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":93.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":89.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":89.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":97.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":94.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":97.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":89.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":94.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":88.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":88.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":105.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":88.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":83.79,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":97.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":101.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":88.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":88.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":92.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":88.20,"methodology":"fee schedule"}]}]},{"description":"Vyjuvek 5x10^9pfu/ml, 0.1 ","code_information":[{"code":"716","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":996.96,"maximum":1196.35,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1021.89,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1066.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1056.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1016.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1016.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1096.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1066.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1096.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1016.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1066.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":996.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":996.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1196.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":996.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1096.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1146.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1001.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":996.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1046.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":996.96,"methodology":"fee schedule"}]}]},{"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":95.21,"maximum":117.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":100.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":105.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":104.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":100.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":100.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":107.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":105.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":107.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":100.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":105.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":98.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":98.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":95.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":117.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":98.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":107.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":112.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":98.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":98.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":103.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":98.15,"methodology":"fee schedule"}]}]},{"description":"Wet mounts, including preparations of vaginal, cervical or skin specimens ","code_information":[{"code":"L000448701","type":"CDM"},{"code":"Q0111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16.09,"maximum":21.31,"gross_charge":58.25,"discounted_cash":58.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.76,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, back upholstery, replacement only, each ","code_information":[{"code":"E0982","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":55.77,"maximum":69.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":58.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":61.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":60.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":63.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":61.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":63.25,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":58.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":61.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":57.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":57.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":69.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":57.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":63.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":66.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":57.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":57.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":57.50,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each ","code_information":[{"code":"E0953","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":103.38,"maximum":127.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":109.24,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":114.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":112.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":114.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":108.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":114.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":106.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":106.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":103.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":127.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":106.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":117.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":122.57,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":107.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":106.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":111.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":106.58,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, power seating system, combination tilt and recline, with power shear reduction ","code_information":[{"code":"E1008","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":968.06,"maximum":1197.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1022.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1067.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1057.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1017.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1017.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1097.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1067.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1097.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1017.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1067.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":998.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":998.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":968.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1197.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":998.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1097.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1147.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1002.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":998.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1047.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":998.00,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable ","code_information":[{"code":"E2626","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":807.05,"maximum":998.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":852.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":890.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":881.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":848.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":848.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":915.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":890.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":915.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":848.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":890.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":832.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":832.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":807.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":998.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":832.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":915.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":956.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":836.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":832.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":873.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":832.01,"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":132.93,"maximum":164.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":132.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.04,"methodology":"fee schedule"}]}]},{"description":"WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE ","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":232138.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":40878.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41875.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":42274.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25593.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":32518.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25593.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":40280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":40280.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36885.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":56728.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36885.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25593.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":43869.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":232138.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":96105.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":232138.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":42274.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 11+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":79390.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":40679.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41875.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42673.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":38685.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41875.59,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":42274.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49851.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":35104.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":43869.66,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":41875.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":44069.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40679.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":102031.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37967.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":39881.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44069.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39083.88,"methodology":"fee schedule"}]}]},{"description":"Xylose absorption test, blood and/or urine ","code_information":[{"code":"84620","type":"CPT"},{"code":"L000195701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.70,"maximum":15.49,"gross_charge":329.25,"discounted_cash":329.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.91,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor VIII (AHG), 1-stage ","code_information":[{"code":"85240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.23,"maximum":21.48,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.90,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor XIII (fibrin stabilizing) ","code_information":[{"code":"85290","type":"CPT"},{"code":"L000202501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.81,"maximum":19.61,"gross_charge":447.25,"discounted_cash":447.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"Coagulation time; activated ","code_information":[{"code":"85347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.88,"maximum":5.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.28,"methodology":"fee schedule"}]}]},{"description":"Collection of venous blood by venipuncture ","code_information":[{"code":"36415","type":"CPT"},{"code":"L000000101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.39,"maximum":12500.00,"gross_charge":18.25,"discounted_cash":18.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":1.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":1.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":1.62,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":3738.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12500.00,"methodology":"case rate"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.83,"methodology":"fee schedule"}]}]},{"description":"Commode chair with integrated seat lift mechanism, electric, any type ","code_information":[{"code":"E0170","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":208.60,"maximum":258.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":220.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":230.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":227.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":219.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":219.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":236.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":230.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":236.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":219.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":230.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":215.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":215.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":208.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":258.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":215.05,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":236.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":247.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":216.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":215.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":225.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":215.05,"methodology":"fee schedule"}]}]},{"description":"Complement fixation tests, each antigen ","code_information":[{"code":"86171","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.07,"maximum":12.01,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.01,"methodology":"fee schedule"}]}]},{"description":"COMPLICATED PEPTIC ULCER WITH MCC ","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":82712.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15113.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15481.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15629.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10323.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13116.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10323.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14891.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14891.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14877.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22881.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14877.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10323.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16218.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":82712.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34242.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":82712.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15629.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28287.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15039.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15481.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15776.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14302.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15481.77,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15629.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18430.68,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12507.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16218.99,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15481.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16292.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15039.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14036.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14744.54,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16292.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14449.65,"methodology":"fee schedule"}]}]},{"description":"Concentration (any type), for infectious agents ","code_information":[{"code":"87015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.05,"maximum":8.02,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"CONNECTIVE TISSUE DISORDERS WITH CC ","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":49761.42,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9431.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9661.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9753.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10024.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12737.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10024.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9293.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9293.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14448.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22220.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14448.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10024.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10121.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49761.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20601.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49761.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9753.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17018.19,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9385.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9661.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9845.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8925.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9661.52,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9753.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11501.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7525.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10121.59,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9661.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10167.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9385.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8759.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9201.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10167.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9017.42,"methodology":"fee schedule"}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC ","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173955.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":108083.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":40279.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":108083.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":88082.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":41262.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41655.11,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":115103.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":105686.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":52300.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":66450.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":52300.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":39690.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":39690.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":75375.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":115923.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":75375.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":52300.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":43227.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72021.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":41655.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":78202.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":40083.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":41262.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42048.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":38118.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41262.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":41655.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49121.59,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":34579.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":43227.00,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":41262.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":43423.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40083.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":90731.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37411.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":39297.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":43423.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":38511.32,"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":22.97,"maximum":28.42,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.68,"methodology":"fee schedule"}]}]},{"description":"CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC ","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":44805.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8576.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8786.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8869.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7256.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9220.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7256.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8451.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8451.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10458.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16085.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10458.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7256.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9204.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":44805.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":18549.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":44805.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8869.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15323.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8535.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8786.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8953.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8116.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8786.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8869.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10459.68,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6775.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9204.52,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8786.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9246.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8535.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7966.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8367.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9246.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8200.39,"methodology":"fee schedule"}]}]},{"description":"Creatine kinase (CK), (CPK); isoenzymes ","code_information":[{"code":"82552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.13,"maximum":16.07,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.39,"methodology":"fee schedule"}]}]},{"description":"Crotalidae Poly Immune Fa ","code_information":[{"code":"9274","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1762.35,"maximum":2114.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1806.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1885.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1868.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1797.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1797.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1938.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1885.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1938.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1797.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1885.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1762.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1762.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2114.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1762.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1938.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2026.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1771.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1762.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1850.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1762.35,"methodology":"fee schedule"}]}]},{"description":"Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine) ","code_information":[{"code":"89060","type":"CPT"},{"code":"L000427001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.64,"maximum":8.80,"gross_charge":588.75,"discounted_cash":588.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.51,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.33,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate ","code_information":[{"code":"87076","type":"CPT"},{"code":"L000337302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.32,"maximum":9.70,"gross_charge":228.00,"discounted_cash":228.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.08,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species ","code_information":[{"code":"87045","type":"CPT"},{"code":"L000332402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.56,"maximum":11.33,"gross_charge":125.00,"discounted_cash":125.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.44,"methodology":"fee schedule"}]}]},{"description":"Culture, mycobacterial, definitive identification, each isolate ","code_information":[{"code":"87118","type":"CPT"},{"code":"L000342302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.24,"maximum":17.53,"gross_charge":306.50,"discounted_cash":306.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.61,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene) ","code_information":[{"code":"87153","type":"CPT"},{"code":"L000346901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":104.56,"maximum":138.43,"gross_charge":483.75,"discounted_cash":483.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":118.24,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":123.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":122.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":117.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":117.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":126.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":123.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":126.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":117.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":123.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":104.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":138.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":109.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":126.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":132.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":115.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":115.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":121.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":115.36,"methodology":"fee schedule"}]}]},{"description":"Cyanocobalamin (Vitamin B-12); ","code_information":[{"code":"82607","type":"CPT"},{"code":"L000105701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.67,"maximum":18.10,"gross_charge":166.50,"discounted_cash":166.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.08,"methodology":"fee schedule"}]}]},{"description":"CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, full gene sequence (List separately in addition to code for primary procedure) ","code_information":[{"code":"0071U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":720.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":615.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":570.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":603.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"}]}]},{"description":"CYP3A5 (cytochrome P450 family 3 subfamily A member 5) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *7) ","code_information":[{"code":"81231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166.07,"maximum":209.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":179.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":185.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":209.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":166.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":201.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":175.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":183.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"}]}]},{"description":"Cytolethal distending toxin B (CdtB) and vinculin IgG antibodies by immunoassay (ie, ELISA) ","code_information":[{"code":"0176U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60.98,"maximum":77.03,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":68.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":68.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":65.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":68.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":77.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":60.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":70.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":73.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":64.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":64.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":67.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64.19,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision ","code_information":[{"code":"88164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.09,"maximum":21.31,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.76,"methodology":"fee schedule"}]}]},{"description":"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC ","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":83984.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15332.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15706.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15856.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7306.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9283.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7306.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15108.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15108.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10530.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16195.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10530.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7306.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16454.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":83984.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34769.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":83984.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15856.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28722.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15257.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15706.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16005.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14509.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15706.50,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15856.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18698.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12700.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16454.43,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15706.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16529.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15257.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14240.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14958.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16529.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14659.40,"methodology":"fee schedule"}]}]},{"description":"Dark field examination, any source (eg, penile, vaginal, oral, skin); without collection ","code_information":[{"code":"87166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.24,"maximum":13.56,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.30,"methodology":"fee schedule"}]}]},{"description":"DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC ","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":57369.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10743.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11005.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11110.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11082.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14080.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11082.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10586.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10586.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15971.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24563.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15971.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11082.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11529.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":57369.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23750.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":57369.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11110.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19620.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10690.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11005.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11214.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10166.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11005.35,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11110.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13101.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8675.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11529.42,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11005.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11581.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10690.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9978.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10481.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11581.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10271.66,"methodology":"fee schedule"}]}]},{"description":"Deoxycortisol, 11- ","code_information":[{"code":"82634","type":"CPT"},{"code":"L000106401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":26.54,"maximum":35.14,"gross_charge":805.25,"discounted_cash":805.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":26.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":32.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":33.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29.28,"methodology":"fee schedule"}]}]},{"description":"Detachable, adjustable height armrest, upper portion, replacement only, each ","code_information":[{"code":"K0018","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":31.57,"maximum":39.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":33.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":33.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":35.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":33.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":39.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":35.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32.55,"methodology":"fee schedule"}]}]},{"description":"DIABETES WITH CC ","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":39424.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7649.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7835.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7910.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8738.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11102.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8738.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7537.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7537.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12593.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19368.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12593.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8738.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8208.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":39424.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16321.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":39424.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7910.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13482.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7611.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7835.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7984.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7238.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7835.58,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7910.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9328.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5961.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8208.70,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7835.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8246.01,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7611.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7104.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7462.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8246.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7313.20,"methodology":"fee schedule"}]}]},{"description":"DIGESTIVE MALIGNANCY WITH CC ","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52813.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9957.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10200.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10297.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11909.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15132.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11909.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9811.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9811.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17164.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26398.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17164.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11909.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10686.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52813.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21864.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52813.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10297.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18061.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9909.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10200.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10394.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9423.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10200.57,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10297.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12143.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7986.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10686.31,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10200.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10734.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9909.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9248.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9714.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10734.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9520.53,"methodology":"fee schedule"}]}]},{"description":"Dimethyl sulfoxide 50% 50 ","code_information":[{"code":"1832","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":715.90,"maximum":859.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":733.80,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":766.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":758.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":730.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":730.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":787.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":766.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":787.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":730.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":766.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":715.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":715.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":859.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":715.90,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":787.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":823.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":719.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":715.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":751.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":715.90,"methodology":"fee schedule"}]}]},{"description":"DISORDERS OF THE BILIARY TRACT WITH CC ","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":46610.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8888.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9105.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9191.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8615.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10946.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8615.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8758.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8758.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12416.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19096.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12416.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8615.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9538.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46610.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19296.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":46610.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9191.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15940.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8844.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9105.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9278.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8411.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9105.01,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9191.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10839.29,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7048.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9538.58,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9105.01,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9581.93,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8844.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8255.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8671.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9581.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8498.01,"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":166.07,"maximum":209.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":179.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":185.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":209.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":166.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":201.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":175.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":183.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"}]}]},{"description":"Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823) ","code_information":[{"code":"0030U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":127.42,"maximum":160.96,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":137.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":143.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":142.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":136.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":136.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":147.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":143.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":147.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":136.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":143.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":160.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":127.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":147.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":154.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":134.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":134.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":140.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":134.13,"methodology":"fee schedule"}]}]},{"description":"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not ","code_information":[{"code":"G0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":180.13,"maximum":238.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":203.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":212.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":210.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":202.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":202.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":218.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":212.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":218.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":202.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":212.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":180.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":238.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":188.80,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":218.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":228.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":199.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":198.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":208.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":198.74,"methodology":"fee schedule"}]}]},{"description":"Dry pressure pad for mattress, standard mattress length and width ","code_information":[{"code":"E0199","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":39.43,"maximum":48.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":43.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":43.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":41.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":41.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":44.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":44.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":41.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":39.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":48.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":44.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":46.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":42.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":40.65,"methodology":"fee schedule"}]}]},{"description":"Eculizumab injection ","code_information":[{"code":"9236","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":224.63,"maximum":269.56,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":230.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":240.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":238.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":229.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":229.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":247.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":240.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":247.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":229.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":240.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":224.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":224.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":269.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":224.63,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":247.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":258.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":225.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":224.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":235.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":224.63,"methodology":"fee schedule"}]}]},{"description":"Electrical stimulation to aid bone healing; noninvasive (nonoperative) ","code_information":[{"code":"20974","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":80.71,"maximum":14520.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":85.29,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":89.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":88.20,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14520.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":13334.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":84.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":84.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":6.90,"standard_charge_algorithm":"Reimbursement will be 6.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_percentage":5.40,"standard_charge_algorithm":"Reimbursement will be 5.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":89.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":3738.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":84.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":89.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":80.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":99.85,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":1950.00,"methodology":"case rate"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":91.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":95.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":83.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":83.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":87.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":83.21,"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":14.57,"maximum":19.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.07,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunofluorescent technique; Bordetella pertussis/parapertussis ","code_information":[{"code":"87265","type":"CPT"},{"code":"L000356201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":14.38,"gross_charge":893.25,"discounted_cash":893.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunofluorescent technique; influenza A virus ","code_information":[{"code":"87276","type":"CPT"},{"code":"L000357501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.57,"maximum":19.28,"gross_charge":329.25,"discounted_cash":329.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.07,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunofluorescent technique; Treponema pallidum ","code_information":[{"code":"87285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.04,"maximum":14.62,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.18,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique ","code_information":[{"code":"87800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39.59,"maximum":52.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":44.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":44.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":39.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":52.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":41.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":48.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":43.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":45.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43.67,"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":31.81,"maximum":42.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":33.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, direct probe technique ","code_information":[{"code":"87485","type":"CPT"},{"code":"L000365102","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":18.17,"maximum":24.06,"gross_charge":477.50,"discounted_cash":477.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.06,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.05,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification ","code_information":[{"code":"87497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38.83,"maximum":51.41,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":40.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":49.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.84,"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":"87507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":377.76,"maximum":500.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":441.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":377.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":500.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":395.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":479.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":418.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":437.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, direct probe technique ","code_information":[{"code":"87525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.01,"maximum":35.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":27.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":32.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29.80,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, includes reverse transcription when performed ","code_information":[{"code":"87535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31.81,"maximum":42.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":33.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) ","code_information":[{"code":"87623","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31.81,"maximum":42.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":33.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria avium-intracellulare, amplified probe technique ","code_information":[{"code":"87561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":31.81,"maximum":42.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":33.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, quantification ","code_information":[{"code":"87557","type":"CPT"},{"code":"L000370301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":38.83,"maximum":51.41,"gross_charge":1219.75,"discounted_cash":1219.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":45.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":38.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":40.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":47.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":49.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique ","code_information":[{"code":"87634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63.62,"maximum":84.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":71.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":75.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":74.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":75.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":75.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":70.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":70.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":63.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":84.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":70.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":66.69,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":80.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":70.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":70.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":73.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":70.20,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique ","code_information":[{"code":"87641","type":"CPT"},{"code":"L000372802","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":31.81,"maximum":42.11,"gross_charge":815.00,"discounted_cash":815.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":33.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Zika virus, amplified probe technique ","code_information":[{"code":"87662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46.50,"maximum":61.57,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":46.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":48.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":56.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.31,"methodology":"fee schedule"}]}]},{"description":"Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus ","code_information":[{"code":"87910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":233.34,"maximum":308.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":263.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":275.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":272.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":262.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":262.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":283.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":275.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":283.19,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":262.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":275.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":233.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":308.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":244.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":283.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":296.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":258.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":270.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":257.45,"methodology":"fee schedule"}]}]},{"description":"Infectious agent, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, multiples amplified probe technique, vaginal, endocervical, or male urine, each pathogen r ","code_information":[{"code":"0402U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129.27,"maximum":171.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":146.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":152.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":156.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":152.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":156.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":152.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":129.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":171.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":135.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":156.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":164.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":143.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":149.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":142.63,"methodology":"fee schedule"}]}]},{"description":"Infectious disease (bacteria, fungi, parasites, and DNA viruses), DNA, PCR and next-generation sequencing, plasma, detection of >1,000 potential microbial organisms for significant positive pathogens ","code_information":[{"code":"0152U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2019.89,"maximum":2551.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2179.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2275.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2253.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2168.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2168.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2338.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2275.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2338.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2168.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2275.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2126.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2126.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2551.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2126.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2019.89,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2338.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2445.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2136.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2126.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2232.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2126.20,"methodology":"fee schedule"}]}]},{"description":"Infectious disease (fungi), fungal pathogen identification, DNA (15 fungal targets), blood culture, amplified probe technique, each target reported as detected or not detected ","code_information":[{"code":"0140U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142.08,"maximum":188.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":160.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":166.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":159.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":159.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":172.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":172.43,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":159.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":167.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":156.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":156.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":142.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":188.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":156.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":148.91,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":172.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":180.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":157.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":156.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":164.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":156.75,"methodology":"fee schedule"}]}]},{"description":"INFLAMMATORY BOWEL DISEASE WITH CC ","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":42656.33,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8206.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8406.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8486.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10942.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13903.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10942.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8086.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8086.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15770.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24253.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15770.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10942.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8806.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":42656.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":17659.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":42656.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8486.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14588.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8166.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8406.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8566.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7766.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8406.52,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8486.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10007.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6450.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8806.83,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8406.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8846.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8166.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7621.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8006.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8846.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7846.08,"methodology":"fee schedule"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47388.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9022.37,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9242.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9330.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7242.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9202.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7242.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8890.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8890.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10437.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16053.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10437.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7242.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9682.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47388.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19618.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47388.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9330.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16206.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8978.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9242.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9418.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8538.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9242.43,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9330.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11002.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7166.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9682.54,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9242.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9726.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8978.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8379.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8802.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9726.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8626.26,"methodology":"fee schedule"}]}]},{"description":"Inj apotex/bendamustine 1 ","code_information":[{"code":"9151","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":15.22,"maximum":18.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.22,"methodology":"fee schedule"}]}]},{"description":"Inj cefazolin sodium, bax ","code_information":[{"code":"9161","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.26,"maximum":1.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.26,"methodology":"fee schedule"}]}]},{"description":"Inj cyclophosphamd aurome ","code_information":[{"code":"9203","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.16,"maximum":1.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.16,"methodology":"fee schedule"}]}]},{"description":"Inj enfort vedo-ejfv 0.25 ","code_information":[{"code":"9364","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":36.74,"maximum":44.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":37.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":37.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":44.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":40.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":42.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36.74,"methodology":"fee schedule"}]}]},{"description":"Inj fosnetupitant, palono ","code_information":[{"code":"9099","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":679.51,"maximum":815.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":696.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":727.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":720.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":693.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":693.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":747.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":727.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":747.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":693.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":727.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":679.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":679.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":815.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":679.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":747.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":781.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":682.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":679.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":713.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":679.51,"methodology":"fee schedule"}]}]},{"description":"Inj human fibrinogen con ","code_information":[{"code":"1478","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.45,"maximum":1.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.45,"methodology":"fee schedule"}]}]},{"description":"Inj labetalol hcl hikma, ","code_information":[{"code":"9402","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.63,"maximum":1.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.63,"methodology":"fee schedule"}]}]},{"description":"Inj mogamulizumab-kpkc, 1 ","code_information":[{"code":"9182","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":238.85,"maximum":286.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":244.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":255.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":253.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":243.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":243.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":262.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":255.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":262.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":243.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":255.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":238.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":238.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":286.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":238.85,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":262.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":274.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":240.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":238.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":250.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":238.85,"methodology":"fee schedule"}]}]},{"description":"Inj pegfilgrast ex bio 0. ","code_information":[{"code":"9436","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":31.14,"maximum":37.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":31.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31.14,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31.14,"methodology":"fee schedule"}]}]},{"description":"Inj plasminogen tvmh 1mg ","code_information":[{"code":"9206","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":32.55,"maximum":39.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":33.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":33.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":35.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":33.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":34.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":39.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":35.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":37.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":32.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":32.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32.55,"methodology":"fee schedule"}]}]},{"description":"Inj romidepsin non-lyo 0. ","code_information":[{"code":"9428","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":33.91,"maximum":40.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34.75,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":34.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":37.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":38.99,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":33.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33.91,"methodology":"fee schedule"}]}]},{"description":"Inj talquetamab-tgvs 0.25 ","code_information":[{"code":"706","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":67.65,"maximum":81.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":69.34,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":71.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":69.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":69.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":74.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":74.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":69.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":72.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":67.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":67.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":81.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":67.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":74.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":77.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":67.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":67.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":71.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":67.65,"methodology":"fee schedule"}]}]},{"description":"Inj travoprost intra impl ","code_information":[{"code":"749","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":197.16,"maximum":236.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":202.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":210.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":208.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":201.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":201.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":216.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":210.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":216.88,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":201.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":210.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":236.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":216.88,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":226.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":198.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":197.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":207.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":197.16,"methodology":"fee schedule"}]}]},{"description":"Inj, abilify maintena, 1 ","code_information":[{"code":"1468","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":7.07,"maximum":8.49,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.14,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.07,"methodology":"fee schedule"}]}]},{"description":"Inj, amisulpride, 1 mg ","code_information":[{"code":"9247","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":9.06,"maximum":10.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.06,"methodology":"fee schedule"}]}]},{"description":"Inj, betibeglogene autote ","code_information":[{"code":"746","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2968000.00,"maximum":3561600.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3042200.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3175760.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3146080.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3027360.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3027360.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3264800.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3175760.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3264800.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3027360.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3175760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2968000.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2968000.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3561600.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2968000.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3264800.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3413200.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2982840.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2968000.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3116400.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2968000.00,"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":688.84,"maximum":1140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":973.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1007.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":688.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":902.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1092.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":954.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"}]}]},{"description":"Neurology (Alzheimer Disease), mRNA, gene expression profiling by RNA sequencing of 24 genes, whole blood, algorithm reported as predictive risk score ","code_information":[{"code":"0289U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722.00,"maximum":912.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":779.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":722.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Neurology Alzheimer Disease Quantitative Imaging ","code_information":[{"code":"0207U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":485.64,"maximum":613.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":523.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":546.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":541.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":521.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":521.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":562.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":546.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":562.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":521.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":546.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":511.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":511.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":613.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":511.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":485.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":562.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":587.88,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":513.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":511.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":536.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":511.20,"methodology":"fee schedule"}]}]},{"description":"New Technology  - Level 1 ","code_information":[{"code":"1492","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":14.98,"maximum":17.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.98,"methodology":"fee schedule"}]}]},{"description":"New Technology  - Level 1 ","code_information":[{"code":"1500","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":43.96,"maximum":52.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":45.06,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":44.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":47.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":52.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":48.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":50.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":44.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":43.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":46.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43.96,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 13 ","code_information":[{"code":"1550","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1111.57,"maximum":1333.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1139.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1189.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1178.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1133.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1133.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1222.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1189.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1222.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1133.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1189.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1111.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1111.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1333.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1111.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1222.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1278.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1117.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1111.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1167.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1111.57,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 17 ","code_information":[{"code":"1554","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1498.03,"maximum":1797.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1535.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1602.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1587.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1527.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1527.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1647.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1602.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1647.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1527.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1602.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1498.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1498.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1797.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1498.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1647.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1722.74,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1505.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1498.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1572.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1498.03,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 20 ","code_information":[{"code":"1557","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1787.88,"maximum":2145.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1832.58,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1913.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1895.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1823.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1823.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1966.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1913.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1966.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1823.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1913.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1787.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1787.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2145.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1787.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1966.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2056.06,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1796.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1787.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1877.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1787.88,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 24 ","code_information":[{"code":"1561","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3140.50,"maximum":3768.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3219.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3360.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3328.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3203.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3203.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3454.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3360.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3454.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3203.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3360.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3768.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3454.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3611.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3156.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3140.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3297.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3140.50,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 28 ","code_information":[{"code":"1565","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5072.82,"maximum":6087.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5199.64,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5427.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5377.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5174.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5174.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5580.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5427.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5580.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5174.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5427.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5072.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5072.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6087.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5072.82,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5580.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5833.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5098.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5072.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5326.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5072.82,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 31 ","code_information":[{"code":"1568","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":6522.06,"maximum":7826.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6685.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6978.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6913.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6652.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6652.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7174.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6978.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7174.27,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6652.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6978.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6522.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6522.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7826.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6522.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7174.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7500.37,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6554.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6522.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6848.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6522.06,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 35 ","code_information":[{"code":"1572","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":8454.38,"maximum":10145.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8665.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9046.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8961.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8623.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8623.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9299.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9046.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9299.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8623.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9046.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8454.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8454.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10145.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8454.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9299.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9722.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8496.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8454.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8877.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8454.38,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 39 ","code_information":[{"code":"1590","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":16908.28,"maximum":20289.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17330.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18091.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17922.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17246.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17246.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18599.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18091.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18599.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17246.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18091.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16908.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16908.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20289.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16908.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18599.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19444.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16992.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16908.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17753.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16908.28,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 42 ","code_information":[{"code":"1593","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":33816.08,"maximum":40579.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34661.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36183.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35845.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34492.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34492.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37197.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36183.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":37197.69,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":34492.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36183.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33816.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33816.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40579.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33816.08,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":37197.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":38888.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":33985.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":33816.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35506.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33816.08,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 46 ","code_information":[{"code":"1597","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":72462.48,"maximum":86954.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":74274.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":77534.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":76810.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":73911.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":73911.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":79708.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":77534.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":79708.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":73911.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":77534.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":86954.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":79708.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":83331.85,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":72824.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":72462.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":76085.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":72462.48,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 5 ","code_information":[{"code":"1542","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":338.64,"maximum":406.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":347.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":362.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":358.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":345.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":345.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":372.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":362.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":372.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":345.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":362.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":338.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":338.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":406.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":338.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":372.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":389.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":340.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":338.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":355.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":338.64,"methodology":"fee schedule"}]}]},{"description":"New Technology - Level 6 ","code_information":[{"code":"1543","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":435.26,"maximum":522.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":446.14,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":465.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":461.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":443.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":443.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":478.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":465.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":478.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":443.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":465.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":522.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":478.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":500.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":437.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":435.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":457.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":435.26,"methodology":"fee schedule"}]}]},{"description":"Nickel ","code_information":[{"code":"83885","type":"CPT"},{"code":"L000170401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":22.21,"maximum":29.41,"gross_charge":163.00,"discounted_cash":163.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.51,"methodology":"fee schedule"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC ","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":150569.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26813.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27467.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27729.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19348.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24583.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19348.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26421.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26421.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27885.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":42885.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27885.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19348.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28775.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":150569.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":62335.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":150569.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27729.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":51494.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":26682.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27467.71,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27990.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25374.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27467.71,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":27729.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32699.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22769.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28775.69,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":27467.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28906.49,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26682.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24904.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26159.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28906.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25636.53,"methodology":"fee schedule"}]}]},{"description":"Nonpowered advanced pressure reducing mattress ","code_information":[{"code":"E0373","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":443.16,"maximum":548.24,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":468.29,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":488.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":484.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":466.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":466.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":502.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":488.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":502.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":466.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":488.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":456.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":456.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":443.16,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":548.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":456.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":502.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":525.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":459.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":456.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":479.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":456.87,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC ","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":38891.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7557.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7741.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7815.16,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12453.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15823.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12453.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7446.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7446.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17948.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27604.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17948.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12453.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8110.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":38891.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16100.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38891.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7815.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13300.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7520.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7741.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7888.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7151.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7741.43,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7815.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9215.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5881.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8110.07,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7741.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8146.93,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7520.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7018.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7372.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8146.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7225.34,"methodology":"fee schedule"}]}]},{"description":"NTRK2 (neurotrophic receptor tyrosine kinase 2) (eg, solid tumors) translocation analysis ","code_information":[{"code":"81192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.94,"maximum":248.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":212.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":219.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":248.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":196.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":208.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":217.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITH MCC ","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":51892.48,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":40858.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21057.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":40858.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":33297.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21571.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21776.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":23411.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":29746.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":23411.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20749.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20749.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":33741.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":51892.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":33741.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":23411.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22598.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":39763.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16462.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":39763.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21776.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":40078.08,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20955.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21571.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21982.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19927.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21571.54,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":21776.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25680.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17721.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22598.75,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":21571.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22701.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20955.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19558.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20544.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22701.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20133.43,"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"},{"code":"L000000901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":45.42,"maximum":78.45,"gross_charge":130.00,"discounted_cash":130.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":49.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":51.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":50.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":51.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":51.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":78.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":45.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":52.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":54.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":48.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":50.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":47.81,"methodology":"fee schedule"}]}]},{"description":"Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy r ","code_information":[{"code":"97166","type":"CPT"},{"code":"T000062501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":95.93,"maximum":118.68,"gross_charge":396.00,"discounted_cash":396.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":101.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":104.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":100.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":100.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":108.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":108.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":100.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":105.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":98.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":98.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":95.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":118.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":98.90,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":108.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":113.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":99.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":98.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":103.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":98.90,"methodology":"fee schedule"}]}]},{"description":"Onc Brst CA Image Alys w/ AI Assmt 12 Features ","code_information":[{"code":"0220U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":670.94,"maximum":847.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":723.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":748.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":720.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":755.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":847.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":670.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":776.88,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":812.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":709.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":706.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":741.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":706.25,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast cancer), DNA, PIK3CA gene analysis of 11 gene variants utilizing plasma, reported as PIK3CA gene mutation status ","code_information":[{"code":"0177U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":249.10,"maximum":329.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":281.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":249.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":261.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"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":3679.35,"maximum":4647.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3969.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4453.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (colon), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence ","code_information":[{"code":"81525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2960.20,"maximum":3739.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3193.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3334.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3302.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3178.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3178.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3427.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3334.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3427.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3178.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3334.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3116.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3116.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3739.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3116.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2960.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3427.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3583.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3131.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3116.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3271.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3116.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (cutaneous melanoma), mRNA, gene expression profiling by real-time RT-PCR of 31 genes (28 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as ","code_information":[{"code":"81529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6833.35,"maximum":8631.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7372.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7696.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7624.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7336.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7336.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7912.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7696.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7912.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7336.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7696.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7193.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7193.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8631.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7193.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6833.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7912.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8271.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7228.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7193.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7552.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7193.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (hematolymphoid neoplasia), RNA, BCR/ABL1 major and minor breakpoint fusion transcripts, quantitative PCR amplification, blood or bone marrow, report of fusion not detected or detected with q ","code_information":[{"code":"0016U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":155.76,"maximum":196.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":168.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":175.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":173.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":175.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":167.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":175.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":196.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":155.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":188.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":164.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":163.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":172.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":163.96,"methodology":"fee schedule"}]}]},{"description":"Oncology (lung), flow cytometry, sputum, 5 markers (meso-tetra porphyrin (TCPP), CD206, CD66b, CD3, CD19), algorithm reported as likelihood of lung cancer ","code_information":[{"code":"0406U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722.00,"maximum":912.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":779.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":722.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (Merkel cell-carcinoma), detection of antibodies to the Merkel cell polyoma virus oncoprotein (small T antigen), serum, quantitative ","code_information":[{"code":"0058U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":306.81,"maximum":387.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":331.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":342.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":387.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":371.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":324.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":339.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":322.96,"methodology":"fee schedule"}]}]},{"description":"Oncology (ovarian), biochemical assays of five proteins (CA-125, apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score ","code_information":[{"code":"81503","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":813.02,"maximum":1076.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":919.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":959.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":950.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":914.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":914.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":986.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":959.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":986.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":914.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":959.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":897.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":897.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":813.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1076.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":897.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":852.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":986.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1031.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":901.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":897.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":941.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":897.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (pancreas), DNA and mRNA next-generation sequencing analysis of 74 genes and analysis of CEA (CEACAM5) gene expression, pancreatic cyst fluid, algorithm reported as a categorical result (ie, ","code_information":[{"code":"0313U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3420.00,"maximum":4320.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3690.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3816.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4320.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3420.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4140.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3618.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (prostate) gene expression profile by real-time RT-PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score ","code_information":[{"code":"0005U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722.00,"maximum":912.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":779.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":722.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (prostate), mRNA, microarray gene expression profiling of 22 content genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as metastasis risk score ","code_information":[{"code":"81542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3679.35,"maximum":4647.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3969.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4105.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4144.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4647.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3679.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4260.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4453.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3892.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"}]}]},{"description":"Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive a ","code_information":[{"code":"E0470","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":201.13,"maximum":248.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":212.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":221.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":219.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":211.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":211.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":228.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":221.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":228.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":211.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":221.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":207.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":207.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":201.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":248.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":207.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":228.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":238.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":208.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":207.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":217.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":207.35,"methodology":"fee schedule"}]}]},{"description":"RESPIRATORY SIGNS AND SYMPTOMS ","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":34854.91,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6861.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7028.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7095.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8944.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11364.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8944.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6760.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6760.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12890.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19825.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12890.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8944.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7363.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":34854.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14429.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":34854.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7095.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11920.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6827.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7028.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7162.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6493.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7028.52,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7095.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8367.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5270.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7363.21,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7028.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7396.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6827.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6372.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6693.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7396.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6559.95,"methodology":"fee schedule"}]}]},{"description":"RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC ","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":89847.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16343.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16742.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16901.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10806.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13729.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10806.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16104.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16104.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15573.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":23951.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15573.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10806.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17539.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":89847.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37196.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":89847.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16901.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":30727.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16263.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16742.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17060.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15466.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16742.08,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16901.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19931.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13586.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17539.32,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16742.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17619.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16263.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15179.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15944.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17619.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15625.94,"methodology":"fee schedule"}]}]},{"description":"Rheumatoid factor; quantitative ","code_information":[{"code":"86431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.14,"maximum":6.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.67,"methodology":"fee schedule"}]}]},{"description":"Rufinamide ","code_information":[{"code":"80210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.57,"maximum":32.53,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.53,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27.11,"methodology":"fee schedule"}]}]},{"description":"Salicylate ","code_information":[{"code":"80179","type":"CPT"},{"code":"L000004301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.90,"maximum":22.37,"gross_charge":78.25,"discounted_cash":78.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.64,"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 and manual rescreening under ","code_information":[{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24.01,"maximum":31.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.49,"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":381.48,"maximum":471.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":403.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":420.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":416.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":401.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":401.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":432.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":420.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":432.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":401.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":420.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":393.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":393.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":381.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":471.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":393.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":432.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":452.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":395.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":393.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":412.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":393.28,"methodology":"fee schedule"}]}]},{"description":"Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptiv ","code_information":[{"code":"97535","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":26.98,"maximum":32.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.98,"methodology":"fee schedule"}]}]},{"description":"Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes ","code_information":[{"code":"97533","type":"CPT"}],"standard_charges":[{"modifiers":"GO|CO","modifiers_description":"Services delivered under an outpatient occupational therapy plan of care|Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","setting":"outpatient","minimum":50.70,"maximum":60.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":51.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":51.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.70,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":60.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":55.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.24,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.70,"methodology":"fee schedule"}]}]},{"description":"Serotonin ","code_information":[{"code":"84260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28.08,"maximum":37.18,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.08,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":31.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":28.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34.08,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35.63,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.98,"methodology":"fee schedule"}]}]},{"description":"Sex hormone binding globulin (SHBG) ","code_information":[{"code":"84270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":19.69,"maximum":26.08,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":20.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.99,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.73,"methodology":"fee schedule"}]}]},{"description":"Sickle cell disease, microfluidic flow adhesion (P-Selectin), whole blood ","code_information":[{"code":"0122U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":499.92,"maximum":631.48,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":539.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":563.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":557.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":536.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":536.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":578.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":563.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":578.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":536.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":563.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":526.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":526.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":631.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":526.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":499.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":578.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":605.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":528.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":526.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":552.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":526.23,"methodology":"fee schedule"}]}]},{"description":"SIMPLE PNEUMONIA AND PLEURISY WITH CC ","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35246.06,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6928.61,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7097.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7165.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20205.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25672.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20205.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6827.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6827.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27297.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":28630.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27297.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20205.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7435.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35246.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14591.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35246.06,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7165.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12054.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6894.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7097.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7232.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6556.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7097.61,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7165.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8449.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5330.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7435.59,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7097.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7469.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6894.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6435.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6759.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7469.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6624.43,"methodology":"fee schedule"}]}]},{"description":"SINUS AND MASTOID PROCEDURES WITH CC/MCC ","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":103627.71,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18719.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19176.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19358.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7633.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9699.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7633.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18445.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18445.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11001.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16920.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11001.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7633.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20089.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":103627.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":42901.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":103627.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19358.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":35440.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18628.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19176.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19541.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17715.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19176.17,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19358.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22828.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15670.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20089.32,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19176.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20180.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18628.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17386.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18263.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20180.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17897.76,"methodology":"fee schedule"}]}]},{"description":"SKIN DEBRIDEMENT WITHOUT CC/MCC ","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":53538.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9318.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9545.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9636.27,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":24154.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":30689.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":24154.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9181.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9181.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":34811.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":53538.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":34811.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":24154.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9999.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49103.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20329.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49103.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9636.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16793.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9272.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9545.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9727.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8818.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9545.36,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9636.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11363.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7425.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9999.90,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9545.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10045.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9272.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8654.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9090.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10045.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8909.00,"methodology":"fee schedule"}]}]},{"description":"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISOR ","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":82269.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15036.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15403.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15550.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":26346.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":33474.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":26346.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14816.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14816.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":37970.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58396.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":37970.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":26346.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16137.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":82269.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34059.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":82269.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15550.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28135.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14963.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15403.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15696.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14229.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15403.56,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15550.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18337.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12441.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16137.07,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15403.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16210.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14963.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13965.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14670.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16210.42,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14376.66,"methodology":"fee schedule"}]}]},{"description":"Skin protection wheelchair seat cushion, adjustable, width 22 inches or greater, any depth ","code_information":[{"code":"E2623","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":465.96,"maximum":576.44,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":492.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":514.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":509.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":489.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":489.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":528.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":514.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":528.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":489.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":514.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":480.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":480.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":465.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":576.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":480.37,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":528.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":552.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":482.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":480.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":504.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":480.37,"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":108.54,"maximum":134.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":114.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":119.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":118.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":114.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":114.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":123.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":119.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":123.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":114.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":119.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":111.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":111.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":108.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":134.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":111.90,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":123.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":128.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":112.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":111.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":117.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":111.90,"methodology":"fee schedule"}]}]},{"description":"Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) ","code_information":[{"code":"87210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.28,"maximum":6.98,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.82,"methodology":"fee schedule"}]}]},{"description":"Sodium; serum, plasma or whole blood ","code_information":[{"code":"84295","type":"CPT"},{"code":"L000185101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.36,"maximum":5.77,"gross_charge":178.00,"discounted_cash":178.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.81,"methodology":"fee schedule"}]}]},{"description":"Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel, interrogation for sequence variants and copy number variants or rearrangements, or isoform exp ","code_information":[{"code":"81456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2773.62,"maximum":3503.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2992.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3094.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3123.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3503.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2773.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3211.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3357.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2934.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3065.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"}]}]},{"description":"Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated) ","code_information":[{"code":"89331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.75,"maximum":23.51,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":21.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.59,"methodology":"fee schedule"}]}]},{"description":"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS ","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":144272.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":44399.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25727.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":44399.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":36183.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26355.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26606.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":33854.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":43014.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":33854.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25351.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25351.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":48791.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":75038.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":48791.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":33854.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":27610.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":144272.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":59728.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":144272.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26606.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":49340.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25602.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26355.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26857.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24347.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26355.44,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":26606.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31375.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21817.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":27610.46,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":26355.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27735.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25602.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":54876.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23895.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25100.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27735.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24598.41,"methodology":"fee schedule"}]}]},{"description":"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC ","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":28863.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5828.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5970.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6027.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6702.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8516.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6702.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5742.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5742.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9660.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14856.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9660.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6702.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6254.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":28863.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":11949.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":28863.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6027.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9871.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5799.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5970.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6083.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5515.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5970.15,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6027.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7107.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4364.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6254.44,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":5970.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6282.87,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5799.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5412.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5685.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6282.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5572.14,"methodology":"fee schedule"}]}]},{"description":"Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing ","code_information":[{"code":"E0439","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":163.89,"maximum":202.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":173.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":180.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":179.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":172.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":172.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":185.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":180.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":185.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":172.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":180.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":202.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":185.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":194.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":169.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":177.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":168.96,"methodology":"fee schedule"}]}]},{"description":"Streptokinase, antibody ","code_information":[{"code":"86590","type":"CPT"},{"code":"L000275501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.48,"maximum":15.19,"gross_charge":244.25,"discounted_cash":244.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.66,"methodology":"fee schedule"}]}]},{"description":"Supplies for external insulin infusion pump, syringe type cartridge, sterile, each ","code_information":[{"code":"A4225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.32,"maximum":4.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.42,"methodology":"fee schedule"}]}]},{"description":"Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) ","code_information":[{"code":"87184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.78,"maximum":8.98,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.48,"methodology":"fee schedule"}]}]},{"description":"Synojoynt, inj., 1 mg ","code_information":[{"code":"9337","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":9.57,"maximum":11.49,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.57,"methodology":"fee schedule"}]}]},{"description":"T cells; absolute CD4 count ","code_information":[{"code":"86361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.27,"maximum":32.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.44,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.78,"methodology":"fee schedule"}]}]},{"description":"Targeted genomic sequence analysis panel, solid organ neoplasm, cell-free circulating DNA analysis of 55-74 genes, interrogation for sequence variants, gene copy number amplifications, and gene rearra ","code_information":[{"code":"0242U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4531.84,"maximum":6000.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5125.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5350.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5300.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5100.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5100.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5500.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5350.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5500.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5100.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5350.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5000.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5000.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4531.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6000.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5000.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4750.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5500.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5750.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5025.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5000.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5250.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5000.00,"methodology":"fee schedule"}]}]},{"description":"Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and m ","code_information":[{"code":"98968","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.26,"maximum":39.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":36.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":36.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":33.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":25.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":39.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":36.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":37.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":32.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":32.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32.83,"methodology":"fee schedule"}]}]},{"description":"TESTES PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":45974.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8778.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8992.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9078.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6389.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8117.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6389.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8650.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8650.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9208.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14161.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9208.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6389.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9420.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":45974.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19033.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":45974.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9078.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15723.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8735.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8992.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9163.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8307.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8992.64,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9078.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10705.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6952.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9420.86,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8992.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9463.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8735.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8153.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8564.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9463.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8393.13,"methodology":"fee schedule"}]}]},{"description":"Theophylline ","code_information":[{"code":"80198","type":"CPT"},{"code":"L000006101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.81,"maximum":16.97,"gross_charge":291.25,"discounted_cash":291.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.14,"methodology":"fee schedule"}]}]},{"description":"Therapeutic procedure(s), group (2 or more individuals) ","code_information":[{"code":"97150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.13,"maximum":21.18,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.65,"methodology":"fee schedule"}]}]},{"description":"Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) ","code_information":[{"code":"97124","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28.47,"maximum":35.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":28.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":32.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":33.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29.35,"methodology":"fee schedule"}]}]},{"description":"Therapeutic services for the use of speech-generating device, including programming and modification ","code_information":[{"code":"92609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97.68,"maximum":120.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":103.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":107.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":106.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":102.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":102.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":110.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":107.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":110.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":102.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":107.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":100.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":100.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":97.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":120.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":100.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":110.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":115.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":101.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":100.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":105.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":100.70,"methodology":"fee schedule"}]}]},{"description":"Level 3 Type A ED Visits ","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":262.65,"maximum":288.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":269.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":288.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":262.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":288.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":262.65,"methodology":"fee schedule"}]}]},{"description":" Trauma Response - Level IV Trauma  ","code_information":[{"code":"684","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":6000.00,"maximum":6000.00,"payers_information":[{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Clear Spring Health","plan_name":"MCR","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":"Evolutions","plan_name":"TieredNetwork","standard_charge_percentage":49.00,"standard_charge_algorithm":"Reimbursement will be 49% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6000.00,"methodology":"case rate"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6000.00,"methodology":"case rate"}]}]},{"description":" Leave of Absence Nursing Home (for Hospitalization)  ","code_information":[{"code":"185","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":6300.00,"maximum":99062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7000.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6300.00,"methodology":"fee schedule"}]}]},{"description":" Room & Board - Other General Classification  ","code_information":[{"code":"160","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":6300.00,"maximum":99062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7000.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6300.00,"methodology":"fee schedule"}]}]},{"description":" Room & Board - Private (One Bed) Psychiatric  ","code_information":[{"code":"114","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1040.00,"maximum":99062.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":2850.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":2850.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2322.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":3677.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":3377.00,"methodology":"per diem"},{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7000.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":8350.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":3457.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":8350.00,"methodology":"per diem"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":1411.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6300.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":1040.00,"methodology":"per diem"}]}]},{"description":" Room & Board - Semi-private (Two Beds) Hospice  ","code_information":[{"code":"125","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":2987.00,"maximum":99062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7000.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6300.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2987.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."}]}]},{"description":" Room & Board - Three and Four Beds Medical/Surgical/GYN  ","code_information":[{"code":"131","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":6300.00,"maximum":99062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7000.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6300.00,"methodology":"fee schedule"}]}]},{"description":" Room & Board - Three and Four Beds Obstetrics (OB)  ","code_information":[{"code":"132","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":6300.00,"maximum":99062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7000.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6300.00,"methodology":"fee schedule"}]}]},{"description":" Room & Board - Ward Psychiatric  ","code_information":[{"code":"154","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1040.00,"maximum":99062.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":2850.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":2850.00,"methodology":"per diem"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2322.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":3677.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":3377.00,"methodology":"per diem"},{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7000.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":8350.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":3457.00,"methodology":"per diem"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":8350.00,"methodology":"per diem"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6650.00,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":1411.00,"methodology":"per diem"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":99062.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6300.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":1040.00,"methodology":"per diem"}]}]},{"description":"1 epidural inject anes-L UNSCHEDULED","code_information":[{"code":"62278","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"1 inject anes-subarach SCHEDULED","code_information":[{"code":"62274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"1 STAGE MOHS, UP TO 5 SPEC SCHEDULED","code_information":[{"code":"17304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"1 subar inject anes-cont UNSCHEDULED","code_information":[{"code":"62277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inhibitor resistance), gene analysis, variants in the kinase domain UNSCHEDULED","code_information":[{"code":"81170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when p SCHEDULED","code_information":[{"code":"20982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when p UNSCHEDULED","code_information":[{"code":"20983","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":845.10,"maximum":939.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":939.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":892.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":845.10,"methodology":"fee schedule"}]}]},{"description":"Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal) SCHEDULED","code_information":[{"code":"30802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Abrasion; single lesion (eg, keratosis, scar) SCHEDULED","code_information":[{"code":"15786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2364.30,"maximum":2627.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2627.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2364.30,"methodology":"fee schedule"}]}]},{"description":"Acetylcholine receptor (AChR); modulating antibody UNSCHEDULED","code_information":[{"code":"86043","type":"CPT"},{"code":"L000453202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"gross_charge":50.50,"discounted_cash":50.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Acoustic reflex testing, threshold SCHEDULED","code_information":[{"code":"92568","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.20,"maximum":18.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":16.20,"methodology":"fee schedule"}]}]},{"description":"Acute venous thrombosis imaging, peptide UNSCHEDULED","code_information":[{"code":"78456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Adding walker to previously applied cast UNSCHEDULED","code_information":[{"code":"29440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":732.60,"maximum":814.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":814.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":773.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":732.60,"methodology":"fee schedule"}]}]},{"description":"Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm UNSCHEDULED","code_information":[{"code":"14301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3222.00,"maximum":3580.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3580.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3401.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3222.00,"methodology":"fee schedule"}]}]},{"description":"Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less SCHEDULED","code_information":[{"code":"14060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4905.00,"maximum":5450.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5450.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5177.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4905.00,"methodology":"fee schedule"}]}]},{"description":"Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less UNSCHEDULED","code_information":[{"code":"14040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":737.10,"maximum":819.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":819.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":778.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":737.10,"methodology":"fee schedule"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm SCHEDULED","code_information":[{"code":"12054","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2364.30,"maximum":2627.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2627.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2364.30,"methodology":"fee schedule"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less UNSCHEDULED","code_information":[{"code":"12041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":369.00,"maximum":410.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":410.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":389.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":369.00,"methodology":"fee schedule"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm UNSCHEDULED","code_information":[{"code":"12046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":875.70,"maximum":973.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":973.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":924.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":875.70,"methodology":"fee schedule"}]}]},{"description":"Repair, laceration of palate; up to 2 cm UNSCHEDULED","code_information":[{"code":"42180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":445.50,"maximum":495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":470.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":445.50,"methodology":"fee schedule"}]}]},{"description":"Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis UNSCHEDULED","code_information":[{"code":"43333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; collateral SCHEDULED","code_information":[{"code":"27695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4120.20,"maximum":4578.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4578.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4349.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4120.20,"methodology":"fee schedule"}]}]},{"description":"Repair, primary, open or percutaneous, ruptured Achilles tendon; UNSCHEDULED","code_information":[{"code":"27650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11441.70,"maximum":12713.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":12713.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":12077.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":11441.70,"methodology":"fee schedule"}]}]},{"description":"Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft) UNSCHEDULED","code_information":[{"code":"27652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2755.80,"maximum":3062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3062.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2908.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2755.80,"methodology":"fee schedule"}]}]},{"description":"Repair, secondary, Achilles tendon, with or without graft SCHEDULED","code_information":[{"code":"27654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6831.00,"maximum":7590.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7590.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7210.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6831.00,"methodology":"fee schedule"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle SCHEDULED","code_information":[{"code":"25265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3411.90,"maximum":3791.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3791.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3601.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3411.90,"methodology":"fee schedule"}]}]},{"description":"Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft) SCHEDULED","code_information":[{"code":"28210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9903.60,"maximum":11004.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11004.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10453.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":9903.60,"methodology":"fee schedule"}]}]},{"description":"Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony def SCHEDULED","code_information":[{"code":"69719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6058.80,"maximum":6732.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6732.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6395.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6058.80,"methodology":"fee schedule"}]}]},{"description":"Replacement of bone flap or prosthetic plate of skull SCHEDULED","code_information":[{"code":"62143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report SCHEDULED","code_information":[{"code":"49451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":786.60,"maximum":874.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":830.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":786.60,"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 SCHEDULED","code_information":[{"code":"49450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1321.20,"maximum":1468.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1468.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1394.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1321.20,"methodology":"fee schedule"}]}]},{"description":"Replacement or irrigation, subarachnoid/subdural catheter SCHEDULED","code_information":[{"code":"62194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus SCHEDULED","code_information":[{"code":"33411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure) UNSCHEDULED","code_information":[{"code":"33412","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation SCHEDULED","code_information":[{"code":"20802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of radial and ulnar shaft fractures; with manipulation UNSCHEDULED","code_information":[{"code":"25565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2246.40,"maximum":2496.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2496.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2371.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2246.40,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement) UNSCHEDULED","code_information":[{"code":"23575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":806.40,"maximum":896.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":896.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":851.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":806.40,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation UNSCHEDULED","code_information":[{"code":"23665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1030.50,"maximum":1145.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1145.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1087.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1030.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of talus fracture; without manipulation SCHEDULED","code_information":[{"code":"28430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of tarsometatarsal joint dislocation; without anesthesia SCHEDULED","code_information":[{"code":"28600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent UNSCHEDULED","code_information":[{"code":"21485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of temporomandibular dislocation; initial or subsequent SCHEDULED","code_information":[{"code":"21480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction UNSCHEDULED","code_information":[{"code":"27752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":765.00,"maximum":850.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":850.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":807.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":765.00,"methodology":"fee schedule"}]}]},{"description":"Closure of gastrostomy, surgical UNSCHEDULED","code_information":[{"code":"43870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1164.60,"maximum":1294.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1294.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1229.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1164.60,"methodology":"fee schedule"}]}]},{"description":"Closure of intestinal cutaneous fistula SCHEDULED","code_information":[{"code":"44640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Closure of laceration, vestibule of mouth; over 2.5 cm or complex SCHEDULED","code_information":[{"code":"40831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2693.70,"maximum":2993.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2993.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2843.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2693.70,"methodology":"fee schedule"}]}]},{"description":"Closure of median sternotomy separation with or without debridement (separate procedure) SCHEDULED","code_information":[{"code":"21750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4602.60,"maximum":5114.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5114.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4858.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4602.60,"methodology":"fee schedule"}]}]},{"description":"Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic approach SCHEDULED","code_information":[{"code":"50526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy SCHEDULED","code_information":[{"code":"57307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Closure of rectovaginal fistula; transperineal approach, with perineal body reconstruction, with or without levator plication SCHEDULED","code_information":[{"code":"57308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Closure of semilunar valve (aortic or pulmonary) by suture or patch UNSCHEDULED","code_information":[{"code":"33602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Closure of the lacrimal punctum; by plug, each UNSCHEDULED","code_information":[{"code":"68761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2344.50,"maximum":2605.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2605.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2474.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2344.50,"methodology":"fee schedule"}]}]},{"description":"Closure salivary fistula SCHEDULED","code_information":[{"code":"42600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"Closure, exstrophy of bladder SCHEDULED","code_information":[{"code":"51940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR E/N/E/L 1.0 CM/< SCHEDULED","code_information":[{"code":"13150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2364.30,"maximum":2627.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2627.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2364.30,"methodology":"fee schedule"}]}]},{"description":"Coccygectomy, primary UNSCHEDULED","code_information":[{"code":"27080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with coloproctostomy (low pelvic anastomosis) UNSCHEDULED","code_information":[{"code":"44145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy UNSCHEDULED","code_information":[{"code":"44146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed UNSCHEDULED","code_information":[{"code":"44158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed SCHEDULED","code_information":[{"code":"44157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"COLLECT BLOOD VENOUS DEVICE SCHEDULED","code_information":[{"code":"36540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) SCHEDULED","code_information":[{"code":"44388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7562.70,"maximum":8403.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8403.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7982.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7562.70,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps UNSCHEDULED","code_information":[{"code":"44392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique SCHEDULED","code_information":[{"code":"44394","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"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) SCHEDULED","code_information":[{"code":"45388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with directed submucosal injection(s), any substance SCHEDULED","code_information":[{"code":"45381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with endoscopic mucosal resection UNSCHEDULED","code_information":[{"code":"45390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Color vision examination, extended, eg, anomaloscope or equivalent SCHEDULED","code_information":[{"code":"92283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41.40,"maximum":46.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":41.40,"methodology":"fee schedule"}]}]},{"description":"Colorectal cancer screening; barium enema SCHEDULED","code_information":[{"code":"G0122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":248.40,"maximum":276.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":276.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":262.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":248.40,"methodology":"fee schedule"}]}]},{"description":"Colorectal cancer screening; colonoscopy on individual at high risk SCHEDULED","code_information":[{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":193.50,"maximum":215.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":215.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":204.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":193.50,"methodology":"fee schedule"}]}]},{"description":"Colostomy or skin level cecostomy; with multiple biopsies (eg, for congenital megacolon) (separate procedure) SCHEDULED","code_information":[{"code":"44322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical) SCHEDULED","code_information":[{"code":"57210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; with enterocele repair SCHEDULED","code_information":[{"code":"57265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12718.80,"maximum":14132.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":14132.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13425.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":12718.80,"methodology":"fee schedule"}]}]},{"description":"Complete repair tetralogy of Fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect SCHEDULED","code_information":[{"code":"33697","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique SCHEDULED","code_information":[{"code":"51727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique UNSCHEDULED","code_information":[{"code":"51727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique UNSCHEDULED","code_information":[{"code":"51728","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) SCHEDULED","code_information":[{"code":"92557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41.40,"maximum":46.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":41.40,"methodology":"fee schedule"}]}]},{"description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording a SCHEDULED","code_information":[{"code":"93654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1207.80,"maximum":1342.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1342.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1274.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1207.80,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing UNSCHEDULED","code_information":[{"code":"72191","type":"CPT"},{"code":"I000079901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2779.20,"maximum":3088.00,"gross_charge":11536.75,"discounted_cash":11536.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3088.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2933.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2779.20,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of left UNSCHEDULED","code_information":[{"code":"75573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1657.80,"maximum":1842.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1842.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1749.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1657.80,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; with contrast material(s) UNSCHEDULED","code_information":[{"code":"73701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2415.60,"maximum":2684.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2684.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2549.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2415.60,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; without contrast material UNSCHEDULED","code_information":[{"code":"73700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1627.20,"maximum":1808.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1808.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1717.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1627.20,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections UNSCHEDULED","code_information":[{"code":"72133","type":"CPT"},{"code":"I000078001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2376.90,"maximum":2641.00,"gross_charge":22449.00,"discounted_cash":22449.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2641.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2508.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2376.90,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thoracic spine; without contrast material UNSCHEDULED","code_information":[{"code":"72128","type":"CPT"},{"code":"I000077001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":1881.90,"maximum":2091.00,"gross_charge":10301.50,"discounted_cash":10301.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2091.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1986.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1881.90,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; with contrast material(s) UNSCHEDULED","code_information":[{"code":"71260","type":"CPT"},{"code":"I000071801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2134.80,"maximum":2372.00,"gross_charge":9678.75,"discounted_cash":9678.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2253.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2134.80,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) UNSCHEDULED","code_information":[{"code":"71271","type":"CPT"},{"code":"I000072201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":549.00,"maximum":610.00,"gross_charge":330.00,"discounted_cash":330.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":610.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":579.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":549.00,"methodology":"fee schedule"}]}]},{"description":"Computerized corneal topography, unilateral or bilateral, with interpretation and report SCHEDULED","code_information":[{"code":"92025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.20,"maximum":18.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":16.20,"methodology":"fee schedule"}]}]},{"description":"Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), incl SCHEDULED","code_information":[{"code":"92549","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.00,"maximum":20.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":18.00,"methodology":"fee schedule"}]}]},{"description":"Conjunctival flap; bridge or partial (separate procedure) UNSCHEDULED","code_information":[{"code":"68360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2344.50,"maximum":2605.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2605.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2474.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2344.50,"methodology":"fee schedule"}]}]},{"description":"Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement UNSCHEDULED","code_information":[{"code":"68326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2344.50,"maximum":2605.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2605.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2474.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2344.50,"methodology":"fee schedule"}]}]},{"description":"Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube SCHEDULED","code_information":[{"code":"68745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1697.40,"maximum":1886.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1886.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1791.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1697.40,"methodology":"fee schedule"}]}]},{"description":"Consultation on X-ray examination made elsewhere, written report UNSCHEDULED","code_information":[{"code":"76140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.90,"maximum":561.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":561.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":532.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":504.90,"methodology":"fee schedule"}]}]},{"description":"Continent ileostomy (Kock procedure) (separate procedure) SCHEDULED","code_information":[{"code":"44316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"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 UNSCHEDULED","code_information":[{"code":"77336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1500.30,"maximum":1667.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1667.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1583.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1500.30,"methodology":"fee schedule"}]}]},{"description":"Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary proced SCHEDULED","code_information":[{"code":"95940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33.30,"maximum":37.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":37.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":33.30,"methodology":"fee schedule"}]}]},{"description":"Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition UNSCHEDULED","code_information":[{"code":"G0453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":103.50,"maximum":115.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":115.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":109.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":103.50,"methodology":"fee schedule"}]}]},{"description":"Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report SCHEDULED","code_information":[{"code":"36598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"CONTRAST X-RAY OF BILE DUCTS UNSCHEDULED","code_information":[{"code":"74320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":700.20,"maximum":778.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":778.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":739.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":700.20,"methodology":"fee schedule"}]}]},{"description":"CONTROL POSTOP BLEEDING UNSCHEDULED","code_information":[{"code":"52606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Coracoacromial ligament release, with or without acromioplasty SCHEDULED","code_information":[{"code":"23415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2554.20,"maximum":2838.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2838.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2696.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2554.20,"methodology":"fee schedule"}]}]},{"description":"Corneal wedge resection for correction of surgically induced astigmatism UNSCHEDULED","code_information":[{"code":"65775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts SCHEDULED","code_information":[{"code":"33534","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts UNSCHEDULED","code_information":[{"code":"33534","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, using arterial graft(s); single arterial graft UNSCHEDULED","code_information":[{"code":"33533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"33518","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"33517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, vein only; 6 or more coronary venous grafts UNSCHEDULED","code_information":[{"code":"33516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"CORONARY ATHERECTOMY UNSCHEDULED","code_information":[{"code":"92995","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7257.60,"maximum":8064.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8064.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7660.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7257.60,"methodology":"fee schedule"}]}]},{"description":"Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight) UNSCHEDULED","code_information":[{"code":"67912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239.30,"maximum":1377.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1377.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1239.30,"methodology":"fee schedule"}]}]},{"description":"Correction of lid retraction SCHEDULED","code_information":[{"code":"67911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4772.70,"maximum":5303.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5303.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5037.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4772.70,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal phalanx osteotomy, any method SCHEDULED","code_information":[{"code":"28298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2512.80,"maximum":2792.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2792.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2652.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2512.80,"methodology":"fee schedule"}]}]},{"description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) UNSCHEDULED","code_information":[{"code":"28285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull SCHEDULED","code_information":[{"code":"61518","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or midline tumor at base of skull UNSCHEDULED","code_information":[{"code":"61518","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"CRANIECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, CEREBELLAR, CORTICAL SCHEDULED","code_information":[{"code":"61870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral, cortical SCHEDULED","code_information":[{"code":"61860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial SCHEDULED","code_information":[{"code":"61321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa) SCHEDULED","code_information":[{"code":"61305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy; with treatment of penetrating wound of brain SCHEDULED","code_information":[{"code":"61571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of cerebellopontine angle tumor; UNSCHEDULED","code_information":[{"code":"61526","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, infratentorial or posterior fossa; for excision of brain abscess SCHEDULED","code_information":[{"code":"61522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, suboccipital; for section of 1 or more cranial nerves SCHEDULED","code_information":[{"code":"61460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial UNSCHEDULED","code_information":[{"code":"61514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial UNSCHEDULED","code_information":[{"code":"61516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy; with excision of tumor or other bone lesion of skull UNSCHEDULED","code_information":[{"code":"61500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital exenteration UNSCHEDULED","code_information":[{"code":"61580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or maxillectomy SCHEDULED","code_information":[{"code":"61581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Cranioplasty for skull defect with reparative brain surgery SCHEDULED","code_information":[{"code":"62145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniotomy for hypophysectomy or excision of pituitary tumor, intracranial approach UNSCHEDULED","code_information":[{"code":"61546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array) SCHEDULED","code_information":[{"code":"61536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery UNSCHEDULED","code_information":[{"code":"61534","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, with electrocorticography during surgery SCHEDULED","code_information":[{"code":"61539","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for lobectomy, temporal lobe, with electrocorticography during surgery SCHEDULED","code_information":[{"code":"61538","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for partial or subtotal (functional) hemispherectomy SCHEDULED","code_information":[{"code":"61543","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for subdural implantation of an electrode array, for long-term seizure monitoring UNSCHEDULED","code_information":[{"code":"61533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Creatinine; clearance UNSCHEDULED","code_information":[{"code":"82575","type":"CPT"},{"code":"L000105201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":29.70,"maximum":33.00,"gross_charge":1751.50,"discounted_cash":1751.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":33.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":29.70,"methodology":"fee schedule"}]}]},{"description":"Creatinine; other source UNSCHEDULED","code_information":[{"code":"82570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":113.40,"maximum":126.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":126.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":119.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":113.40,"methodology":"fee schedule"}]}]},{"description":"Creation of distal arteriovenous fistula during lower extremity bypass surgery (non-hemodialysis) (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"35686","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); gasserian ganglion UNSCHEDULED","code_information":[{"code":"61790","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Creation of pericardial window or partial resection for drainage SCHEDULED","code_information":[{"code":"33025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including laminectomy UNSCHEDULED","code_information":[{"code":"63740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus SCHEDULED","code_information":[{"code":"62192","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Creation of shunt; ventriculo-atrial, -jugular, -auricular UNSCHEDULED","code_information":[{"code":"62220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Creation of shunt; ventriculo-peritoneal, -pleural, other terminus UNSCHEDULED","code_information":[{"code":"62223","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Cricotracheal resection SCHEDULED","code_information":[{"code":"31592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes SCHEDULED","code_information":[{"code":"99291","type":"CPT"},{"code":"E000001101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":227.70,"maximum":253.00,"gross_charge":9632.75,"discounted_cash":9632.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":253.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":240.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":227.70,"methodology":"fee schedule"}]}]},{"description":"Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes UNSCHEDULED","code_information":[{"code":"99291","type":"CPT"},{"code":"E000001101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":1598.40,"maximum":1776.00,"gross_charge":9632.75,"discounted_cash":9632.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1776.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1687.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1598.40,"methodology":"fee schedule"}]}]},{"description":"Cross intrinsic transfer, each tendon UNSCHEDULED","code_information":[{"code":"26510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Cross-over vein graft to venous system SCHEDULED","code_information":[{"code":"34520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Cryofibrinogen UNSCHEDULED","code_information":[{"code":"82585","type":"CPT"},{"code":"L000105301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":38.70,"maximum":43.00,"gross_charge":237.75,"discounted_cash":237.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":43.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":38.70,"methodology":"fee schedule"}]}]},{"description":"CRYOTHERAPY OF RECTAL LESION SCHEDULED","code_information":[{"code":"46938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2247.30,"maximum":2497.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2497.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2247.30,"methodology":"fee schedule"}]}]},{"description":"CRYOTHERAPY OF RECTAL LESION UNSCHEDULED","code_information":[{"code":"46937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"CT GUIDE FOR TISSUE ABLATION UNSCHEDULED","code_information":[{"code":"76362","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.90,"maximum":561.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":561.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":532.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":504.90,"methodology":"fee schedule"}]}]},{"description":"CT SCAN FOR THERAPY GUIDE UNSCHEDULED","code_information":[{"code":"76370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.90,"maximum":561.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":561.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":532.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":504.90,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate UNSCHEDULED","code_information":[{"code":"87077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83.70,"maximum":93.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":93.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":83.70,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates UNSCHEDULED","code_information":[{"code":"87075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":159.30,"maximum":177.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":177.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":168.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":159.30,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) UNSCHEDULED","code_information":[{"code":"87040","type":"CPT"},{"code":"L000332202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":218.70,"maximum":243.00,"gross_charge":962.00,"discounted_cash":962.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":243.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":230.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":218.70,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species UNSCHEDULED","code_information":[{"code":"87045","type":"CPT"},{"code":"L000332402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":220.50,"maximum":245.00,"gross_charge":125.00,"discounted_cash":125.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":245.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":220.50,"methodology":"fee schedule"}]}]},{"description":"Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates UNSCHEDULED","code_information":[{"code":"87116","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":283.50,"maximum":315.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":315.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":299.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":283.50,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; identification by nucleic acid sequencing method, each isolate (eg, sequencing of the 16S rRNA gene) UNSCHEDULED","code_information":[{"code":"87153","type":"CPT"},{"code":"L000346901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":195.30,"maximum":217.00,"gross_charge":483.75,"discounted_cash":483.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":217.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":206.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":195.30,"methodology":"fee schedule"}]}]},{"description":"Cyanide UNSCHEDULED","code_information":[{"code":"82600","type":"CPT"},{"code":"L000105501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":23.40,"maximum":26.00,"gross_charge":526.00,"discounted_cash":526.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":23.40,"methodology":"fee schedule"}]}]},{"description":"Cyclic citrullinated peptide (CCP), antibody UNSCHEDULED","code_information":[{"code":"86200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135.00,"maximum":150.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":142.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":135.00,"methodology":"fee schedule"}]}]},{"description":"CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *8, *17) UNSCHEDULED","code_information":[{"code":"81225","type":"CPT"},{"code":"L000049802","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"gross_charge":170.75,"discounted_cash":170.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes SCHEDULED","code_information":[{"code":"51575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cysto w tumor resection SCHEDULED","code_information":[{"code":"52339","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior Y-plasty, vesical fundus resection), any procedure, with or without wedge resection of posterior vesical n SCHEDULED","code_information":[{"code":"51800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystorrhaphy, suture of bladder wound, injury or rupture; simple UNSCHEDULED","code_information":[{"code":"51860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus SCHEDULED","code_information":[{"code":"51065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystotomy; for excision of bladder diverticulum, single or multiple (separate procedure) UNSCHEDULED","code_information":[{"code":"51525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus SCHEDULED","code_information":[{"code":"52320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material UNSCHEDULED","code_information":[{"code":"52327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy with irrigation and evacuation of multiple obstructing clots SCHEDULED","code_information":[{"code":"52001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated UNSCHEDULED","code_information":[{"code":"52315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple SCHEDULED","code_information":[{"code":"52310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with resection of external sphincter (sphincterotomy) SCHEDULED","code_information":[{"code":"52277","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; SCHEDULED","code_information":[{"code":"52005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5257.80,"maximum":5842.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5842.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5549.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5257.80,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion UNSCHEDULED","code_information":[{"code":"52354","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) SCHEDULED","code_information":[{"code":"52356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, evaluation of fine needle aspirate; interpretation and report UNSCHEDULED","code_information":[{"code":"88173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250.20,"maximum":278.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":278.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":264.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":250.20,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation UNSCHEDULED","code_information":[{"code":"88104","type":"CPT"},{"code":"L000391702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":72.90,"maximum":81.00,"gross_charge":140.00,"discounted_cash":140.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":81.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":72.90,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology UNSCHEDULED","code_information":[{"code":"88121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.70,"maximum":153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":137.70,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision UNSCHEDULED","code_information":[{"code":"88164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.70,"maximum":153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":137.70,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE SKIN, FULL UNSCHEDULED","code_information":[{"code":"11041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1099.80,"maximum":1222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1160.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1099.80,"methodology":"fee schedule"}]}]},{"description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues UNSCHEDULED","code_information":[{"code":"11010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2997.00,"maximum":3330.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3330.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3163.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2997.00,"methodology":"fee schedule"}]}]},{"description":"Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"11001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2312.10,"maximum":2569.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2569.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2440.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2312.10,"methodology":"fee schedule"}]}]},{"description":"Debridement of nail(s) by any method(s); 6 or more SCHEDULED","code_information":[{"code":"11721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1979.10,"maximum":2199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2089.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1979.10,"methodology":"fee schedule"}]}]},{"description":"Debridement of nail(s) by any method(s); 6 or more UNSCHEDULED","code_information":[{"code":"11721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":424.80,"maximum":472.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":472.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":448.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":424.80,"methodology":"fee schedule"}]}]},{"description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure SCHEDULED","code_information":[{"code":"11005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8548.20,"maximum":9498.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9498.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9023.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8548.20,"methodology":"fee schedule"}]}]},{"description":"Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning) SCHEDULED","code_information":[{"code":"69222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4519.80,"maximum":5022.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5022.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4770.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4519.80,"methodology":"fee schedule"}]}]},{"description":"Debridement, mastoidectomy cavity, simple (eg, routine cleaning) SCHEDULED","code_information":[{"code":"69220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4519.80,"maximum":5022.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5022.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4770.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4519.80,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only UNSCHEDULED","code_information":[{"code":"27600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2755.80,"maximum":3062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3062.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2908.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2755.80,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve UNSCHEDULED","code_information":[{"code":"27892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2755.80,"maximum":3062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3062.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2908.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2755.80,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s) SCHEDULED","code_information":[{"code":"27602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Decompression; unspecified nerve(s) (specify) SCHEDULED","code_information":[{"code":"64722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Decompressive fasciotomy, hand (excludes 26035) SCHEDULED","code_information":[{"code":"26037","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":480.60,"maximum":534.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":534.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":507.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":480.60,"methodology":"fee schedule"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet UNSCHEDULED","code_information":[{"code":"15620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3575.70,"maximum":3973.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3973.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3774.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3575.70,"methodology":"fee schedule"}]}]},{"description":"Delayed creation of exit site from embedded subcutaneous segment of intraperitoneal cannula or catheter UNSCHEDULED","code_information":[{"code":"49436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4673.70,"maximum":5193.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5193.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4933.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4673.70,"methodology":"fee schedule"}]}]},{"description":"Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device SCHEDULED","code_information":[{"code":"94664","type":"CPT"},{"code":"R000005601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.20,"maximum":18.00,"gross_charge":223.25,"discounted_cash":223.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":16.20,"methodology":"fee schedule"}]}]},{"description":"DESTR PARAVERTEBRAL N ADD-ON UNSCHEDULED","code_information":[{"code":"64627","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions UNSCHEDULED","code_information":[{"code":"17110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed UNSCHEDULED","code_information":[{"code":"64624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus UNSCHEDULED","code_information":[{"code":"64681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm SCHEDULED","code_information":[{"code":"17108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1173.60,"maximum":1304.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1304.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1238.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1173.60,"methodology":"fee schedule"}]}]},{"description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm UNSCHEDULED","code_information":[{"code":"17108","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF HEMORRHOIDS SCHEDULED","code_information":[{"code":"46936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2247.30,"maximum":2497.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2497.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2247.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency) SCHEDULED","code_information":[{"code":"46930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2247.30,"maximum":2497.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2497.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2247.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) SCHEDULED","code_information":[{"code":"46924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2247.30,"maximum":2497.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2497.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2247.30,"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 UNSCHEDULED","code_information":[{"code":"17280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm UNSCHEDULED","code_information":[{"code":"17271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm SCHEDULED","code_information":[{"code":"17276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument SCHEDULED","code_information":[{"code":"96110","type":"CPT"},{"code":"T000047101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":79.20,"maximum":88.00,"gross_charge":663.25,"discounted_cash":663.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":88.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":83.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":79.20,"methodology":"fee schedule"}]}]},{"description":"Diagnostic analysis of cochlear implant, age 7 years or older; with programming SCHEDULED","code_information":[{"code":"92603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123.30,"maximum":137.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":123.30,"methodology":"fee schedule"}]}]},{"description":"Diagnostic analysis of cochlear implant, patient younger than 7 years of age; subsequent reprogramming UNSCHEDULED","code_information":[{"code":"92602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.20,"maximum":218.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":218.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":207.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":196.20,"methodology":"fee schedule"}]}]},{"description":"Diagnostic analysis with programming of auditory brainstem implant, per hour SCHEDULED","code_information":[{"code":"92640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":97.20,"maximum":108.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":108.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":102.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":97.20,"methodology":"fee schedule"}]}]},{"description":"Digoxin; total UNSCHEDULED","code_information":[{"code":"80162","type":"CPT"},{"code":"L000002701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":115.20,"maximum":128.00,"gross_charge":291.25,"discounted_cash":291.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":128.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":121.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":115.20,"methodology":"fee schedule"}]}]},{"description":"Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, w SCHEDULED","code_information":[{"code":"50436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, w SCHEDULED","code_information":[{"code":"50437","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Dilation of female urethra including suppository and/or instillation; initial UNSCHEDULED","code_information":[{"code":"53660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6759.90,"maximum":7511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7135.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6759.90,"methodology":"fee schedule"}]}]},{"description":"Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use UNSCHEDULED","code_information":[{"code":"90702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal ao UNSCHEDULED","code_information":[{"code":"35091","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, hepatic, cel UNSCHEDULED","code_information":[{"code":"35121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, iliac artery SCHEDULED","code_information":[{"code":"35131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, carotid, subclavian artery, by neck incision UNSCHEDULED","code_information":[{"code":"35002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, common femoral artery (profunda femoris, superficial UNSCHEDULED","code_information":[{"code":"35142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, popliteal artery SCHEDULED","code_information":[{"code":"35152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, splenic artery SCHEDULED","code_information":[{"code":"35112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Disarticulation of shoulder; SCHEDULED","code_information":[{"code":"23920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6361.20,"maximum":7068.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7068.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6714.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6361.20,"methodology":"fee schedule"}]}]},{"description":"Discission of vitreous strands (without removal), pars plana approach SCHEDULED","code_information":[{"code":"67030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5356.80,"maximum":5952.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5952.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5654.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5356.80,"methodology":"fee schedule"}]}]},{"description":"Discography, cervical or thoracic, radiological supervision and interpretation UNSCHEDULED","code_information":[{"code":"72285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1860.30,"maximum":2067.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2067.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1963.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1860.30,"methodology":"fee schedule"}]}]},{"description":"Discography, lumbar, radiological supervision and interpretation UNSCHEDULED","code_information":[{"code":"72295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3299.40,"maximum":3666.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3666.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3482.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3299.40,"methodology":"fee schedule"}]}]},{"description":"Division of scalenus anticus; with resection of cervical rib SCHEDULED","code_information":[{"code":"21705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4602.60,"maximum":5114.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5114.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4858.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4602.60,"methodology":"fee schedule"}]}]},{"description":"Division of sternocleidomastoid for torticollis, open operation; without cast application SCHEDULED","code_information":[{"code":"21720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4602.60,"maximum":5114.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5114.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4858.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4602.60,"methodology":"fee schedule"}]}]},{"description":"DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A COMPREHENSIVE INTERVAL HISTORY; A COMPREHENSIVE EXAMI SCHEDULED","code_information":[{"code":"99337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195.30,"maximum":217.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":217.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":206.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":195.30,"methodology":"fee schedule"}]}]},{"description":"Donor cardiectomy (including cold preservation) SCHEDULED","code_information":[{"code":"33940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Donor cardiectomy-pneumonectomy (including cold preservation) SCHEDULED","code_information":[{"code":"33930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral SCHEDULED","code_information":[{"code":"50300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral UNSCHEDULED","code_information":[{"code":"50300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"Drainage abscess or hematoma, nasal, internal approach SCHEDULED","code_information":[{"code":"30000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess, cyst, hematoma from dentoalveolar structures SCHEDULED","code_information":[{"code":"41800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6150.60,"maximum":6834.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6834.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6492.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6150.60,"methodology":"fee schedule"}]}]},{"description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area) UNSCHEDULED","code_information":[{"code":"16025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":309.60,"maximum":344.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":344.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":326.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":309.60,"methodology":"fee schedule"}]}]},{"description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) UNSCHEDULED","code_information":[{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":243.90,"maximum":271.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":271.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":243.90,"methodology":"fee schedule"}]}]},{"description":"Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3 UNSCHEDULED","code_information":[{"code":"80375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118.80,"maximum":132.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":132.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":125.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":118.80,"methodology":"fee schedule"}]}]},{"description":"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) UNSCHEDULED","code_information":[{"code":"77081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187.20,"maximum":208.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":208.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":197.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":187.20,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study SCHEDULED","code_information":[{"code":"93978","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142.20,"maximum":158.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":158.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":150.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":142.20,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study SCHEDULED","code_information":[{"code":"93979","type":"CPT"},{"code":"I000178401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":92.70,"maximum":103.00,"gross_charge":277.75,"discounted_cash":277.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":103.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":97.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":92.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components UNSCHEDULED","code_information":[{"code":"43774","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1164.60,"maximum":1294.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1294.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1229.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1164.60,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED SCHEDULED","code_information":[{"code":"49657","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15668.10,"maximum":17409.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":17409.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":16538.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":15668.10,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE SCHEDULED","code_information":[{"code":"49652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10976.40,"maximum":12196.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":12196.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":11586.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":10976.40,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE UNSCHEDULED","code_information":[{"code":"49652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4673.70,"maximum":5193.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5193.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4933.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4673.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed SCHEDULED","code_information":[{"code":"50542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; cholecystoenterostomy SCHEDULED","code_information":[{"code":"47570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy SCHEDULED","code_information":[{"code":"44208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy SCHEDULED","code_information":[{"code":"44205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed UNSCHEDULED","code_information":[{"code":"44211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy SCHEDULED","code_information":[{"code":"44212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; donor nephrectomy (including cold preservation), from living donor SCHEDULED","code_information":[{"code":"50547","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis UNSCHEDULED","code_information":[{"code":"44202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; nephrectomy with total ureterectomy UNSCHEDULED","code_information":[{"code":"50548","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; nephrectomy, including partial ureterectomy UNSCHEDULED","code_information":[{"code":"50546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; orchiectomy SCHEDULED","code_information":[{"code":"54690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9654.30,"maximum":10727.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":10727.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10190.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":9654.30,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when per UNSCHEDULED","code_information":[{"code":"45397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy UNSCHEDULED","code_information":[{"code":"45395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"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 SCHEDULED","code_information":[{"code":"38573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5097.60,"maximum":5664.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5664.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5380.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5097.60,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity UNSCHEDULED","code_information":[{"code":"49323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4673.70,"maximum":5193.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5193.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4933.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4673.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with revision of previously placed intraperitoneal cannula or catheter, with removal of intraluminal obstructive material if performed SCHEDULED","code_information":[{"code":"49325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"Laryngectomy; subtotal supraglottic, without radical neck dissection SCHEDULED","code_information":[{"code":"31367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older UNSCHEDULED","code_information":[{"code":"31552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn UNSCHEDULED","code_information":[{"code":"31525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2679.30,"maximum":2977.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2977.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2828.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2679.30,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy direct, with or without tracheoscopy; for aspiration SCHEDULED","code_information":[{"code":"31515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with biopsy; SCHEDULED","code_information":[{"code":"31535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3120.30,"maximum":3467.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3467.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3293.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3120.30,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with biopsy; UNSCHEDULED","code_information":[{"code":"31535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescope SCHEDULED","code_information":[{"code":"31531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft) UNSCHEDULED","code_information":[{"code":"31546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; UNSCHEDULED","code_information":[{"code":"31570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral SCHEDULED","code_information":[{"code":"31572","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, indirect; with biopsy SCHEDULED","code_information":[{"code":"31510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, indirect; with removal of lesion UNSCHEDULED","code_information":[{"code":"31512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, indirect; with vocal cord injection SCHEDULED","code_information":[{"code":"31513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laser interstitial thermal therapy (LITT) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion SCHEDULED","code_information":[{"code":"61736","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium) UNSCHEDULED","code_information":[{"code":"31000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"LEFT HEART CATHETERIZATION UNSCHEDULED","code_information":[{"code":"93514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10276.20,"maximum":11418.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11418.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10847.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":10276.20,"methodology":"fee schedule"}]}]},{"description":"LEFT VENTRICULAR RECORDING UNSCHEDULED","code_information":[{"code":"93607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9296.10,"maximum":10329.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":10329.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9812.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":9296.10,"methodology":"fee schedule"}]}]},{"description":"Lengthening of palate, with island flap SCHEDULED","code_information":[{"code":"42227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2242.80,"maximum":2492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2367.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2242.80,"methodology":"fee schedule"}]}]},{"description":"Lengthening of tendon, extensor, hand or finger, each tendon UNSCHEDULED","code_information":[{"code":"26476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Leukocyte assessment, fecal, qualitative or semiquantitative UNSCHEDULED","code_information":[{"code":"89055","type":"CPT"},{"code":"L000426901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.10,"maximum":19.00,"gross_charge":121.25,"discounted_cash":121.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":17.10,"methodology":"fee schedule"}]}]},{"description":"Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is loca UNSCHEDULED","code_information":[{"code":"G0380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":180.90,"maximum":201.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":201.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":190.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":180.90,"methodology":"fee schedule"}]}]},{"description":"Ligamentous reconstruction (augmentation), knee; extra-articular UNSCHEDULED","code_information":[{"code":"27427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Ligation arteries; ethmoidal UNSCHEDULED","code_information":[{"code":"30915","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":479.70,"maximum":533.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":533.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":506.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":479.70,"methodology":"fee schedule"}]}]},{"description":"Ligation arteries; internal maxillary artery, transantral SCHEDULED","code_information":[{"code":"30920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg UNSCHEDULED","code_information":[{"code":"37761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg UNSCHEDULED","code_information":[{"code":"37760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, blood; electrophoretic separation and quantitation UNSCHEDULED","code_information":[{"code":"83700","type":"CPT"},{"code":"L000165701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"gross_charge":315.75,"discounted_cash":315.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, direct measurement; small dense LDL cholesterol UNSCHEDULED","code_information":[{"code":"83722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Lithotripsy, extracorporeal shock wave UNSCHEDULED","code_information":[{"code":"50590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"Liver and spleen imaging; with vascular flow UNSCHEDULED","code_information":[{"code":"78216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report SCHEDULED","code_information":[{"code":"91200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.50,"maximum":25.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":22.50,"methodology":"fee schedule"}]}]},{"description":"Liver imaging; static only UNSCHEDULED","code_information":[{"code":"78201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day SCHEDULED","code_information":[{"code":"97610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.90,"maximum":21.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":21.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":18.90,"methodology":"fee schedule"}]}]},{"description":"Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative) SCHEDULED","code_information":[{"code":"20979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Lung transplant, single; without cardiopulmonary bypass SCHEDULED","code_information":[{"code":"32851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2166.30,"maximum":2407.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2286.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2166.30,"methodology":"fee schedule"}]}]},{"description":"Lung transplant, single; without cardiopulmonary bypass UNSCHEDULED","code_information":[{"code":"32851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1427.40,"maximum":1586.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1586.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1506.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1427.40,"methodology":"fee schedule"}]}]},{"description":"LYME DISEASE VACCINE IM UNSCHEDULED","code_information":[{"code":"90665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences UNSCHEDULED","code_information":[{"code":"73720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3709.80,"maximum":4122.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4122.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3915.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3709.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) UNSCHEDULED","code_information":[{"code":"70542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1961.10,"maximum":2179.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2179.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2070.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1961.10,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences UNSCHEDULED","code_information":[{"code":"70543","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3690.90,"maximum":4101.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4101.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3895.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3690.90,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, pelvis, with or without contrast material(s) UNSCHEDULED","code_information":[{"code":"72198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1860.30,"maximum":2067.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2067.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1963.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1860.30,"methodology":"fee schedule"}]}]},{"description":"MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT SCHEDULED","code_information":[{"code":"19324","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3659.40,"maximum":4066.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4066.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3862.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3659.40,"methodology":"fee schedule"}]}]},{"description":"Manganese UNSCHEDULED","code_information":[{"code":"83785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.20,"maximum":8.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7.20,"methodology":"fee schedule"}]}]},{"description":"Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) UNSCHEDULED","code_information":[{"code":"27860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4692.60,"maximum":5214.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5214.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4953.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4692.60,"methodology":"fee schedule"}]}]},{"description":"Manipulation, elbow, under anesthesia SCHEDULED","code_information":[{"code":"24300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3357.00,"maximum":3730.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3730.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3543.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3357.00,"methodology":"fee schedule"}]}]},{"description":"Manipulation, wrist, under anesthesia SCHEDULED","code_information":[{"code":"25259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2428.20,"maximum":2698.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2698.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2563.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2428.20,"methodology":"fee schedule"}]}]},{"description":"Marsupialization of sublingual salivary cyst (ranula) UNSCHEDULED","code_information":[{"code":"42409","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3762.90,"maximum":4181.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4181.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3971.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3762.90,"methodology":"fee schedule"}]}]},{"description":"Marsupialization of urethral diverticulum, male or female UNSCHEDULED","code_information":[{"code":"53240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6759.90,"maximum":7511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7135.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6759.90,"methodology":"fee schedule"}]}]},{"description":"MASTECTOMY, SUBCUTANEOUS SCHEDULED","code_information":[{"code":"19304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3659.40,"maximum":4066.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4066.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3862.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3659.40,"methodology":"fee schedule"}]}]},{"description":"Mechanical chest wall oscillation to facilitate lung function, per session UNSCHEDULED","code_information":[{"code":"94669","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes SCHEDULED","code_information":[{"code":"97804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.20,"maximum":18.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":18.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":16.20,"methodology":"fee schedule"}]}]},{"description":"Microdissection (ie, sample preparation of microscopically identified target); laser capture UNSCHEDULED","code_information":[{"code":"88380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":584.10,"maximum":649.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":649.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":616.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":584.10,"methodology":"fee schedule"}]}]},{"description":"Microsatellite instability analysis (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (eg, BAT25, BAT26), includes comparison of neoplastic and UNSCHEDULED","code_information":[{"code":"81301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"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 UNSCHEDULED","code_information":[{"code":"81293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure) UNSCHEDULED","code_information":[{"code":"65125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2681.10,"maximum":2979.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2979.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2830.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2681.10,"methodology":"fee schedule"}]}]},{"description":"MOHS ANY STAGE > 5 SPEC EACH UNSCHEDULED","code_information":[{"code":"17310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"MOLECULAR RNA STABILIZATION UNSCHEDULED","code_information":[{"code":"83913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"MOLECULE MUTATION IDENTIFY UNSCHEDULED","code_information":[{"code":"83904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Morphometric analysis; skeletal muscle UNSCHEDULED","code_information":[{"code":"88355","type":"CPT"},{"code":"L000423402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":244.80,"maximum":272.00,"gross_charge":399.75,"discounted_cash":399.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":272.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":258.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":244.80,"methodology":"fee schedule"}]}]},{"description":"Morphometric analysis; tumor (eg, DNA ploidy) UNSCHEDULED","code_information":[{"code":"88358","type":"CPT"},{"code":"L000423602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":244.80,"maximum":272.00,"gross_charge":803.75,"discounted_cash":803.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":272.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":258.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":244.80,"methodology":"fee schedule"}]}]},{"description":"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R) UNSCHEDULED","code_information":[{"code":"81338","type":"CPT"},{"code":"L000061702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"gross_charge":314.50,"discounted_cash":314.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"MSH6 (mutS homolog 6 ºE. coli») (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants UNSCHEDULED","code_information":[{"code":"81299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Multifetal pregnancy reduction(s) (MPR) SCHEDULED","code_information":[{"code":"59866","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.40,"maximum":26.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":23.40,"methodology":"fee schedule"}]}]},{"description":"Multiple osteotomies with realignment on intramedullary rod, humeral shaft (Sofield type procedure) SCHEDULED","code_information":[{"code":"24410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6528.60,"maximum":7254.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7254.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6891.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6528.60,"methodology":"fee schedule"}]}]},{"description":"Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo) UNSCHEDULED","code_information":[{"code":"65600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae) UNSCHEDULED","code_information":[{"code":"15733","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"Muscle, myocutaneous, or fasciocutaneous flap; lower extremity SCHEDULED","code_information":[{"code":"15738","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2066.40,"maximum":2296.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2296.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2181.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2066.40,"methodology":"fee schedule"}]}]},{"description":"Muscle, myocutaneous, or fasciocutaneous flap; upper extremity UNSCHEDULED","code_information":[{"code":"15736","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1752.30,"maximum":1947.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1947.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1849.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1752.30,"methodology":"fee schedule"}]}]},{"description":"MYD88 (myeloid differentiation primary response 88) (eg, Waldenstrom's macroglobulinemia, lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant UNSCHEDULED","code_information":[{"code":"81305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Myelin oligodendrocyte glycoprotein (MOG-IgG1) antibody; flow cytometry (ie, fluorescence-activated cell sorting ºFACS»), each UNSCHEDULED","code_information":[{"code":"86363","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification UNSCHEDULED","code_information":[{"code":"78469","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique UNSCHEDULED","code_information":[{"code":"78468","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantificat UNSCHEDULED","code_information":[{"code":"78452","type":"CPT"},{"code":"I000166801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3182.40,"maximum":3536.00,"gross_charge":20958.00,"discounted_cash":20958.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3536.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3359.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3182.40,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, diagnostic; with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium) SCHEDULED","code_information":[{"code":"31235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3699.00,"maximum":4110.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4110.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3904.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3699.00,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) UNSCHEDULED","code_information":[{"code":"31255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium SCHEDULED","code_information":[{"code":"31296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4502.70,"maximum":5003.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5003.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4752.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4502.70,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium SCHEDULED","code_information":[{"code":"31297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4502.70,"maximum":5003.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5003.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4752.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4502.70,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed SCHEDULED","code_information":[{"code":"31276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2559.60,"maximum":2844.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2844.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2701.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2559.60,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed UNSCHEDULED","code_information":[{"code":"31276","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with optic nerve decompression UNSCHEDULED","code_information":[{"code":"31294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage SCHEDULED","code_information":[{"code":"31238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3699.00,"maximum":4110.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4110.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3904.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3699.00,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery UNSCHEDULED","code_information":[{"code":"31241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Natural killer (NK) cells, total count UNSCHEDULED","code_information":[{"code":"86357","type":"CPT"},{"code":"L000268801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":100.80,"maximum":112.00,"gross_charge":1026.50,"discounted_cash":1026.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":112.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":106.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":100.80,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography studies (EMG) of anal or urethral sphincter, any technique SCHEDULED","code_information":[{"code":"51785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography studies (EMG) of anal or urethral sphincter, any technique UNSCHEDULED","code_information":[{"code":"51785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code f UNSCHEDULED","code_information":[{"code":"95885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":262.80,"maximum":292.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":292.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":277.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":262.80,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography; 3 extremities with or without related paraspinal areas SCHEDULED","code_information":[{"code":"95863","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":107.10,"maximum":119.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":119.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":113.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":107.10,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography; 3 extremities with or without related paraspinal areas UNSCHEDULED","code_information":[{"code":"95863","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":285.30,"maximum":317.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":317.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":301.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":285.30,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12) SCHEDULED","code_information":[{"code":"95869","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72.90,"maximum":81.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":81.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":76.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":72.90,"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 SCHEDULED","code_information":[{"code":"97607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.30,"maximum":27.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":27.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":24.30,"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 SCHEDULED","code_information":[{"code":"97608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.00,"maximum":30.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":30.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":28.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":27.00,"methodology":"fee schedule"}]}]},{"description":"Nephrectomy, including partial ureterectomy, any open approach including rib resection; SCHEDULED","code_information":[{"code":"50220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Nephrorrhaphy, suture of kidney wound or injury UNSCHEDULED","code_information":[{"code":"50500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"Nerve conduction studies; 13 or more studies UNSCHEDULED","code_information":[{"code":"95913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1523.70,"maximum":1693.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1693.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1608.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1523.70,"methodology":"fee schedule"}]}]},{"description":"Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length SCHEDULED","code_information":[{"code":"64892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2658.60,"maximum":2954.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2954.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2806.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2658.60,"methodology":"fee schedule"}]}]},{"description":"Nerve pedicle transfer; first stage SCHEDULED","code_information":[{"code":"64905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2412.00,"maximum":2680.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2680.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2546.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2412.00,"methodology":"fee schedule"}]}]},{"description":"Nerve pedicle transfer; first stage UNSCHEDULED","code_information":[{"code":"64905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Nerve repair; with nerve allograft, each nerve, first strand (cable) UNSCHEDULED","code_information":[{"code":"64912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2470.50,"maximum":2745.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2745.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2607.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2470.50,"methodology":"fee schedule"}]}]},{"description":"Neurectomy, hamstring muscle SCHEDULED","code_information":[{"code":"27325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or external drainage (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"62160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any 1 method SCHEDULED","code_information":[{"code":"95937","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56.70,"maximum":63.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":63.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":56.70,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty and/or transposition; median nerve at carpal tunnel UNSCHEDULED","code_information":[{"code":"64721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3563.10,"maximum":3959.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3959.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3761.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3563.10,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus SCHEDULED","code_information":[{"code":"64714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7383.60,"maximum":8204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7793.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7383.60,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve UNSCHEDULED","code_information":[{"code":"64712","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical SCHEDULED","code_information":[{"code":"96132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108.90,"maximum":121.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":121.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":114.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":108.90,"methodology":"fee schedule"}]}]},{"description":"Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional Doppler waveform or volume plethysmography recording and analysis at res SCHEDULED","code_information":[{"code":"93924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.20,"maximum":148.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":148.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":140.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":133.20,"methodology":"fee schedule"}]}]},{"description":"Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional Doppler waveform or volume plethysmography recording and analysis at res UNSCHEDULED","code_information":[{"code":"93924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":655.20,"maximum":728.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":728.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":691.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":655.20,"methodology":"fee schedule"}]}]},{"description":"NUCLEAR MED DATA PROC UNSCHEDULED","code_information":[{"code":"78891","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"NUCLEIC ACID SIGNAL AMPLI UNSCHEDULED","code_information":[{"code":"83908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"NUDT15 (nudix hydrolase 15) (eg, drug metabolism) gene analysis, common variant(s) (eg, *2, *3, *4, *5, *6) UNSCHEDULED","code_information":[{"code":"81306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Nursing facility discharge management; more than 30 minutes total time on the date of the encounter SCHEDULED","code_information":[{"code":"99316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106.20,"maximum":118.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":118.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":112.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":106.20,"methodology":"fee schedule"}]}]},{"description":"Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft) UNSCHEDULED","code_information":[{"code":"65782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision makin SCHEDULED","code_information":[{"code":"99215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112.50,"maximum":125.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":125.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":118.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":112.50,"methodology":"fee schedule"}]}]},{"description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making SCHEDULED","code_information":[{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":52.20,"maximum":58.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":58.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":52.20,"methodology":"fee schedule"}]}]},{"description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making UNSCHEDULED","code_information":[{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119.70,"maximum":133.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":126.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":119.70,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), mRNA gene expression profiling by hybrid capture of 58 genes (50 content and 8 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence r UNSCHEDULED","code_information":[{"code":"81520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58.50,"maximum":65.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":65.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":61.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":58.50,"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 UNSCHEDULED","code_information":[{"code":"81540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58.50,"maximum":65.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":65.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":61.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":58.50,"methodology":"fee schedule"}]}]},{"description":"Oncoprotein; des-gamma-carboxy-prothrombin (DCP) UNSCHEDULED","code_information":[{"code":"83951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"OPEN BIOPSY CHEST LINING UNSCHEDULED","code_information":[{"code":"32402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1427.40,"maximum":1586.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1586.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1506.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1427.40,"methodology":"fee schedule"}]}]},{"description":"Open femoral artery exposure for delivery of endovascular prosthesis, by groin incision, unilateral (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"34812","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition SCHEDULED","code_information":[{"code":"34714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Open iliac artery exposure for delivery of endovascular prosthesis or iliac occlusion during endovascular therapy, by abdominal or retroperitoneal incision, unilateral (List separately in addition to SCHEDULED","code_information":[{"code":"34820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Open iliac artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by abdominal or retroperitoneal incision, unilateral (List s SCHEDULED","code_information":[{"code":"34833","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array SCHEDULED","code_information":[{"code":"64582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis SCHEDULED","code_information":[{"code":"34830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting UNSCHEDULED","code_information":[{"code":"22319","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation SCHEDULED","code_information":[{"code":"27227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8869.50,"maximum":9855.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9855.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9362.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8869.50,"methodology":"fee schedule"}]}]},{"description":"Open treatment of acute or chronic elbow dislocation SCHEDULED","code_information":[{"code":"24615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7250.40,"maximum":8056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7653.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7250.40,"methodology":"fee schedule"}]}]},{"description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; with repair or internal or external fixation SCHEDULED","code_information":[{"code":"27848","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2075.40,"maximum":2306.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2306.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2190.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2075.40,"methodology":"fee schedule"}]}]},{"description":"Open treatment of calcaneal fracture, includes internal fixation, when performed; UNSCHEDULED","code_information":[{"code":"28415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14464.80,"maximum":16072.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":16072.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15268.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14464.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed SCHEDULED","code_information":[{"code":"25628","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6562.80,"maximum":7292.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7292.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6927.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6562.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when performed, each joint UNSCHEDULED","code_information":[{"code":"26685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9905.40,"maximum":11006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10455.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":9905.40,"methodology":"fee schedule"}]}]},{"description":"Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft) SCHEDULED","code_information":[{"code":"21366","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches UNSCHEDULED","code_information":[{"code":"21344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation) SCHEDULED","code_information":[{"code":"21435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of craniofacial separation (LeFort III type); with wiring and/or internal fixation SCHEDULED","code_information":[{"code":"21432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of depressed zygomatic arch fracture (eg, Gillies approach) UNSCHEDULED","code_information":[{"code":"21356","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments UNSCHEDULED","code_information":[{"code":"25608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7757.10,"maximum":8619.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8619.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8188.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7757.10,"methodology":"fee schedule"}]}]},{"description":"Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement SCHEDULED","code_information":[{"code":"27236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8179.20,"maximum":9088.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9088.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8633.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8179.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of femoral shaft fracture with plate/screws, with or without cerclage SCHEDULED","code_information":[{"code":"27507","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, includes internal fixation, when performed UNSCHEDULED","code_information":[{"code":"27513","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft) UNSCHEDULED","code_information":[{"code":"21408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"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 SCHEDULED","code_information":[{"code":"27828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10549.80,"maximum":11722.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11722.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":11135.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":10549.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed UNSCHEDULED","code_information":[{"code":"24575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; without intercondylar extension SCHEDULED","code_information":[{"code":"24545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14060.70,"maximum":15623.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":15623.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":14841.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14060.70,"methodology":"fee schedule"}]}]},{"description":"Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair, with augmentation/reconstruction SCHEDULED","code_information":[{"code":"27558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Open treatment of mandibular condylar fracture SCHEDULED","code_information":[{"code":"21465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of mandibular fracture; with interdental fixation UNSCHEDULED","code_information":[{"code":"21462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17980.20,"maximum":19978.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":19978.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":18979.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":17980.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of nasoethmoid fracture; without external fixation UNSCHEDULED","code_information":[{"code":"21338","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches UNSCHEDULED","code_information":[{"code":"21347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of orbital floor blowout fracture; combined approach SCHEDULED","code_information":[{"code":"21387","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6576.30,"maximum":7307.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7307.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6941.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6576.30,"methodology":"fee schedule"}]}]},{"description":"Open treatment of patellar dislocation, with or without partial or total patellectomy SCHEDULED","code_information":[{"code":"27566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2340.00,"maximum":2600.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2600.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2470.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2340.00,"methodology":"fee schedule"}]}]},{"description":"Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair SCHEDULED","code_information":[{"code":"27524","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7910.10,"maximum":8789.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8789.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8349.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7910.10,"methodology":"fee schedule"}]}]},{"description":"Open treatment of posterior malleolus fracture, includes internal fixation, when performed UNSCHEDULED","code_information":[{"code":"27769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2755.80,"maximum":3062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3062.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2908.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2755.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius OR ulna SCHEDULED","code_information":[{"code":"25574","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":600.30,"maximum":667.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":667.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":633.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":600.30,"methodology":"fee schedule"}]}]},{"description":"Open treatment of radial shaft fracture, includes internal fixation, when performed UNSCHEDULED","code_information":[{"code":"25515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6970.50,"maximum":7745.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7745.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7357.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6970.50,"methodology":"fee schedule"}]}]},{"description":"Open treatment of radial shaft fracture, includes internal fixation, when performed, and closed treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes percutaneous SCHEDULED","code_information":[{"code":"25525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21317.40,"maximum":23686.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":23686.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":22501.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":21317.40,"methodology":"fee schedule"}]}]},{"description":"Open treatment of radiocarpal or intercarpal dislocation, 1 or more bones SCHEDULED","code_information":[{"code":"25670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6323.40,"maximum":7026.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7026.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6674.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6323.40,"methodology":"fee schedule"}]}]},{"description":"Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed UNSCHEDULED","code_information":[{"code":"23585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"Open treatment of sternum fracture with or without skeletal fixation SCHEDULED","code_information":[{"code":"21825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4602.60,"maximum":5114.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5114.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4858.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4602.60,"methodology":"fee schedule"}]}]},{"description":"Open treatment of trans-scaphoperilunar type of fracture dislocation SCHEDULED","code_information":[{"code":"25685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6948.00,"maximum":7720.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7720.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7334.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6948.00,"methodology":"fee schedule"}]}]},{"description":"Open treatment of ulnar shaft fracture, includes internal fixation, when performed SCHEDULED","code_information":[{"code":"25545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12715.20,"maximum":14128.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":14128.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13421.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":12715.20,"methodology":"fee schedule"}]}]},{"description":"Operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure); without cardiopulmonary bypass UNSCHEDULED","code_information":[{"code":"33255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Operculectomy, excision pericoronal tissues UNSCHEDULED","code_information":[{"code":"41821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":326.70,"maximum":363.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":363.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":344.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":326.70,"methodology":"fee schedule"}]}]},{"description":"Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter UNSCHEDULED","code_information":[{"code":"76510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":632.70,"maximum":703.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":703.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":667.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":632.70,"methodology":"fee schedule"}]}]},{"description":"Ophthalmic ultrasound, diagnostic; quantitative A-scan only UNSCHEDULED","code_information":[{"code":"76511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":632.70,"maximum":703.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":703.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":667.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":632.70,"methodology":"fee schedule"}]}]},{"description":"Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits SCHEDULED","code_information":[{"code":"92014","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79.20,"maximum":88.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":88.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":83.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":79.20,"methodology":"fee schedule"}]}]},{"description":"OPHTHALMOSCOPY, EXTENDED, WITH RETINAL DRAWING (EG, FOR RETINAL DETACHMENT, MELANOMA), WITH INTERPRETATION AND REPORT; SUBSEQUENT UNSCHEDULED","code_information":[{"code":"92226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":387.90,"maximum":431.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":431.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":409.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":387.90,"methodology":"fee schedule"}]}]},{"description":"Opponensplasty; other methods SCHEDULED","code_information":[{"code":"26496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4054.50,"maximum":4505.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4505.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4054.50,"methodology":"fee schedule"}]}]},{"description":"Orbicularis oculi (blink) reflex, by electrodiagnostic testing SCHEDULED","code_information":[{"code":"95933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48.60,"maximum":54.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":54.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":51.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":48.60,"methodology":"fee schedule"}]}]},{"description":"Orchiectomy, radical, for tumor; with abdominal exploration SCHEDULED","code_information":[{"code":"54535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5758.20,"maximum":6398.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6398.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6078.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5758.20,"methodology":"fee schedule"}]}]},{"description":"Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens) SCHEDULED","code_information":[{"code":"54650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5758.20,"maximum":6398.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6398.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6078.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5758.20,"methodology":"fee schedule"}]}]},{"description":"Orthopantogram (eg, panoramic x-ray) UNSCHEDULED","code_information":[{"code":"70355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245.70,"maximum":273.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":273.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":259.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":245.70,"methodology":"fee schedule"}]}]},{"description":"Orthoptic training; under supervision of a physician or other qualified health care professional UNSCHEDULED","code_information":[{"code":"92066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":387.90,"maximum":431.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":431.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":409.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":387.90,"methodology":"fee schedule"}]}]},{"description":"Oscillating tracking test, with recording SCHEDULED","code_information":[{"code":"92545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.20,"maximum":8.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7.20,"methodology":"fee schedule"}]}]},{"description":"Ostectomy of scapula, partial (eg, superior medial angle) UNSCHEDULED","code_information":[{"code":"23190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"Ostectomy, calcaneus; UNSCHEDULED","code_information":[{"code":"28118","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure) UNSCHEDULED","code_information":[{"code":"28114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Ostectomy, complete excision; first metatarsal head SCHEDULED","code_information":[{"code":"28111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Ostectomy, complete excision; other metatarsal head (second, third or fourth) UNSCHEDULED","code_information":[{"code":"28112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Osteoplasty, femur; shortening (excluding 64876) SCHEDULED","code_information":[{"code":"27465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"22226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical SCHEDULED","code_information":[{"code":"22210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2864.70,"maximum":3183.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3183.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3023.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2864.70,"methodology":"fee schedule"}]}]},{"description":"Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) UNSCHEDULED","code_information":[{"code":"22216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment (List separately in addition to cod SCHEDULED","code_information":[{"code":"22208","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5043.60,"maximum":5604.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5604.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5323.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5043.60,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, femur, shaft or supracondylar; with fixation UNSCHEDULED","code_information":[{"code":"27450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or cast SCHEDULED","code_information":[{"code":"27165","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8869.50,"maximum":9855.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9855.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9362.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8869.50,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus ºbowleg» or genu valgus ºknock-knee»); after epiphyseal closure UNSCHEDULED","code_information":[{"code":"27457","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, radius; distal third UNSCHEDULED","code_information":[{"code":"25350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3509.10,"maximum":3899.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3899.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3704.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3509.10,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, shortening, angular or rotational correction; other phalanges, any toe SCHEDULED","code_information":[{"code":"28312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3038.40,"maximum":3376.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3376.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3207.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3038.40,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure) SCHEDULED","code_information":[{"code":"28310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal SCHEDULED","code_information":[{"code":"28306","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6693.30,"maximum":7437.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7437.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7065.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6693.30,"methodology":"fee schedule"}]}]},{"description":"Osteotomy; metacarpal, each SCHEDULED","code_information":[{"code":"26565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2324.70,"maximum":2583.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2583.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2453.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2324.70,"methodology":"fee schedule"}]}]},{"description":"Osteotomy; multiple, with realignment on intramedullary rod (eg, Sofield type procedure) SCHEDULED","code_information":[{"code":"27712","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5598.00,"maximum":6220.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6220.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5909.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5598.00,"methodology":"fee schedule"}]}]},{"description":"Osteotomy; phalanx of finger, each SCHEDULED","code_information":[{"code":"26567","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6394.50,"maximum":7105.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7105.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6749.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6394.50,"methodology":"fee schedule"}]}]},{"description":"Osteotomy; talus UNSCHEDULED","code_information":[{"code":"28302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Osteotomy; ulna SCHEDULED","code_information":[{"code":"25360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8154.00,"maximum":9060.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9060.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8607.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8154.00,"methodology":"fee schedule"}]}]},{"description":"Osteotomy; ulna UNSCHEDULED","code_information":[{"code":"25360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3509.10,"maximum":3899.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3899.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3704.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3509.10,"methodology":"fee schedule"}]}]},{"description":"Other cranial decompression, posterior fossa UNSCHEDULED","code_information":[{"code":"61345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Other spinal injection SCHEDULED","code_information":[{"code":"62298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Otoplasty, protruding ear, with or without size reduction SCHEDULED","code_information":[{"code":"69300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4519.80,"maximum":5022.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5022.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4770.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4519.80,"methodology":"fee schedule"}]}]},{"description":"Ova and parasites, direct smears, concentration and identification UNSCHEDULED","code_information":[{"code":"87177","type":"CPT"},{"code":"L000347801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":198.00,"maximum":220.00,"gross_charge":98.50,"discounted_cash":98.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":220.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":209.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":198.00,"methodology":"fee schedule"}]}]},{"description":"Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen extracted SCHEDULED","code_information":[{"code":"94681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40.50,"maximum":45.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":45.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":40.50,"methodology":"fee schedule"}]}]},{"description":"PABPN1 (polyºA» binding protein nuclear 1) (eg, oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles UNSCHEDULED","code_information":[{"code":"81312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Palatoplasty for cleft palate, soft and/or hard palate only SCHEDULED","code_information":[{"code":"42200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2242.80,"maximum":2492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2367.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2242.80,"methodology":"fee schedule"}]}]},{"description":"Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only SCHEDULED","code_information":[{"code":"42205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2242.80,"maximum":2492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2367.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2242.80,"methodology":"fee schedule"}]}]},{"description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous UNSCHEDULED","code_information":[{"code":"65800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection UNSCHEDULED","code_information":[{"code":"65815","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) UNSCHEDULED","code_information":[{"code":"78071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Paravertebral block (PVB) (paraspinous block), thoracic; continuous infusion by catheter (includes imaging guidance, when performed) SCHEDULED","code_information":[{"code":"64463","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"PAROTID DUCT DIVERSION SCHEDULED","code_information":[{"code":"42508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands SCHEDULED","code_information":[{"code":"42509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"\"Nephrology (renal transplant), RNA expression by select transcriptome sequencing, using pretransplant peripheral blood, algorithm reported as a risk scorefor early acute rejection\" ","code_information":[{"code":"0319U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2517.50,"maximum":3180.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2716.25,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2835.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2809.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2703.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2703.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2915.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2835.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2915.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2703.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2835.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3180.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2517.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2915.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3047.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2663.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2650.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2782.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2650.00,"methodology":"fee schedule"}]}]},{"description":"ABORTION WITHOUT D&C ","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":40176.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7778.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7968.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8044.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":3625.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":4606.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":3625.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7664.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7664.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":5225.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":8036.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":5225.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":3625.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8347.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":40176.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16632.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40176.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8044.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13740.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7740.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7968.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8120.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7361.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7968.44,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8044.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9486.24,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6075.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8347.89,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7968.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8385.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7740.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7224.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7588.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8385.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7437.21,"methodology":"fee schedule"}]}]},{"description":"ACTH stimulation panel; for 3 beta-hydroxydehydrogenase deficiency This panel must include the following: Cortisol (82533 x 2) 17 hydroxypregnenolone (84143 x 2) ","code_information":[{"code":"80406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70.94,"maximum":93.91,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":80.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":82.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":86.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":86.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":79.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":83.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":78.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":78.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":70.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":93.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":78.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":74.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":86.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":90.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":78.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":78.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":82.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":78.26,"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":"L000001201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":43.17,"maximum":57.16,"gross_charge":489.25,"discounted_cash":489.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":48.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":43.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":57.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":45.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":52.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":47.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":47.63,"methodology":"fee schedule"}]}]},{"description":"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC ","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":55669.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":21334.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13017.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":21334.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":17385.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13334.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13461.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19598.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24901.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19598.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12826.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12826.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28246.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":43441.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28246.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19598.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13969.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":55669.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23048.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":55669.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13461.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24130.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12953.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13334.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13588.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12318.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13334.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13461.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15874.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10669.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13969.65,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13334.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14033.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12953.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":33741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12090.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12699.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14033.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12445.69,"methodology":"fee schedule"}]}]},{"description":"Adalimumab injection ","code_information":[{"code":"1083","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1834.49,"maximum":2201.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1880.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1962.91,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1944.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1871.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1871.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2017.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1962.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2017.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1871.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1962.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1834.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1834.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2201.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1834.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2017.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2109.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1843.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1834.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1926.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1834.49,"methodology":"fee schedule"}]}]},{"description":"ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC ","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":97949.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17740.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18173.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18346.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":29616.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":37628.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":29616.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17480.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17480.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":42683.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":65644.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":42683.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":29616.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19038.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":97949.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":40551.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":97949.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18346.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":33498.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17654.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18173.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18519.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16788.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18173.23,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":18346.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21634.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14812.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19038.62,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18173.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19125.16,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17654.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16477.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17307.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19125.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16961.68,"methodology":"fee schedule"}]}]},{"description":"Afamelanotide implant, 1 ","code_information":[{"code":"9396","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2873.33,"maximum":3447.99,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2945.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3074.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3045.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2930.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2930.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3160.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3074.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3160.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2930.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3074.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2873.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2873.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3447.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2873.33,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3160.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3304.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2887.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2873.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3017.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2873.33,"methodology":"fee schedule"}]}]},{"description":"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC ","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35142.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6910.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7079.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7146.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8726.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11087.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8726.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6809.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6809.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12576.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19341.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12576.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8726.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7416.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35142.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14549.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35142.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7146.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12018.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6877.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7079.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7214.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6540.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7079.38,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7146.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8427.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5314.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7416.50,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7079.38,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7450.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6877.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6418.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6742.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7450.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6607.42,"methodology":"fee schedule"}]}]},{"description":"Albumin (human), 25%, 50m ","code_information":[{"code":"965","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":53.08,"maximum":63.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":54.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":54.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":54.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":54.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":56.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":53.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":53.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":63.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":53.08,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":58.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":61.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":53.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":53.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":55.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":53.08,"methodology":"fee schedule"}]}]},{"description":"Alcohol (ethanol); any specimen except urine and breath, immunoassay (eg, IA, EIA, ELISA, RIA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase) ","code_information":[{"code":"82077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.41,"maximum":20.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"Aldosterone ","code_information":[{"code":"82088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36.94,"maximum":48.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":43.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":43.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":41.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":41.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":41.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":36.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":48.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":38.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":44.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":46.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":40.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":40.75,"methodology":"fee schedule"}]}]},{"description":"ALLERGIC REACTIONS WITH MCC ","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":74695.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13730.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14065.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14199.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4953.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":6293.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4953.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13529.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13529.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":7138.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":10978.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":7138.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4953.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14735.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":74695.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":30924.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":74695.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14199.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25545.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13663.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14065.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14333.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12994.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14065.80,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14199.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16745.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11295.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14735.60,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14065.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14802.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13663.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12752.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13396.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14802.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13128.08,"methodology":"fee schedule"}]}]},{"description":"Alpha-fetoprotein (AFP); serum ","code_information":[{"code":"82105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.20,"maximum":20.12,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.77,"methodology":"fee schedule"}]}]},{"description":"Amines, vaginal fluid, qualitative ","code_information":[{"code":"82120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.43,"maximum":7.19,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.99,"methodology":"fee schedule"}]}]},{"description":"Aminolevulinic acid, delta (ALA) ","code_information":[{"code":"82135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.91,"maximum":19.74,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.45,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC ","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":216483.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38179.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39110.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39482.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":28084.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":35683.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":28084.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":37620.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37620.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":40475.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":62249.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":40475.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":28084.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40972.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":216483.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":89624.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":216483.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39482.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 12+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":74036.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":37993.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39110.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":39855.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36130.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":39110.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":39482.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":46560.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":32737.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":40972.88,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":39110.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":41159.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":37993.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35460.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37248.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":41159.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36503.11,"methodology":"fee schedule"}]}]},{"description":"Amylase ","code_information":[{"code":"82150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.87,"maximum":7.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.48,"methodology":"fee schedule"}]}]},{"description":"Androstenedione ","code_information":[{"code":"82157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26.54,"maximum":35.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":26.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":32.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":33.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29.28,"methodology":"fee schedule"}]}]},{"description":"Anti-inhibitor ","code_information":[{"code":"929","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.34,"maximum":2.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.34,"methodology":"fee schedule"}]}]},{"description":"Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); antibody identification by qualitative panel using complete HLA phenotypes, HLA Class ","code_information":[{"code":"86831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74.21,"maximum":98.26,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":83.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":87.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":86.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":90.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":87.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":90.07,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":83.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":87.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":74.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":98.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":77.79,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":90.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":94.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":82.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":81.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":85.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":81.88,"methodology":"fee schedule"}]}]},{"description":"Antibody, Treponema pallidum, total and rapid plasma reagin (RPR), immunoassay, qualitative ","code_information":[{"code":"0064U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28.39,"maximum":37.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":31.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":36.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":32.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31.33,"methodology":"fee schedule"}]}]},{"description":"Antibody; Borrelia (relapsing fever) ","code_information":[{"code":"86619","type":"CPT"},{"code":"L000284801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.13,"maximum":16.06,"gross_charge":369.25,"discounted_cash":369.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.38,"methodology":"fee schedule"}]}]},{"description":"Antibody; Coccidioides ","code_information":[{"code":"86635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.40,"maximum":13.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.90,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.47,"methodology":"fee schedule"}]}]},{"description":"Antibody; encephalitis, Eastern equine ","code_information":[{"code":"86652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.95,"maximum":15.83,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"Antibody; fungus, not elsewhere specified ","code_information":[{"code":"86671","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.11,"maximum":14.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.25,"methodology":"fee schedule"}]}]},{"description":"Antibody; herpes simplex, type 2 ","code_information":[{"code":"86696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.54,"maximum":23.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"Antibody; influenza virus ","code_information":[{"code":"86710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.28,"maximum":16.26,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.89,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.55,"methodology":"fee schedule"}]}]},{"description":"Antibody; mumps ","code_information":[{"code":"86735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.82,"maximum":15.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.05,"methodology":"fee schedule"}]}]},{"description":"Antibody; Rickettsia ","code_information":[{"code":"86757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.54,"maximum":23.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"Antibody; Toxoplasma ","code_information":[{"code":"86777","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.05,"maximum":17.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"Antibody; Yersinia ","code_information":[{"code":"86793","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.95,"maximum":15.83,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"}]}]},{"description":"Antinuclear antibodies (ANA); ","code_information":[{"code":"86038","type":"CPT"},{"code":"L000223701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":10.96,"maximum":14.51,"gross_charge":125.00,"discounted_cash":125.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for ","code_information":[{"code":"81411","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1282.68,"maximum":1620.23,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1383.94,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1444.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1431.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1377.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1377.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1485.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1444.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1485.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1377.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1444.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1620.23,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1282.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1485.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1552.72,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1356.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1350.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1417.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1350.19,"methodology":"fee schedule"}]}]},{"description":"APPENDIX PROCEDURES WITH CC ","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":65046.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12067.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12361.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12479.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16768.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":21305.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16768.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11890.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11890.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":24167.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":37168.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":24167.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16768.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12949.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":65046.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":26929.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":65046.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12479.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22245.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12008.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12361.34,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12596.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11419.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12361.34,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12479.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14715.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9836.45,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12949.97,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12361.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13008.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12008.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11207.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11772.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13008.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11537.25,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; infrared ","code_information":[{"code":"97026","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.36,"maximum":7.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.55,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; ultrasound, each 15 minutes ","code_information":[{"code":"97035","type":"CPT"}],"standard_charges":[{"modifiers":"GO|CO","modifiers_description":"Services delivered under an outpatient occupational therapy plan of care|Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","setting":"outpatient","minimum":11.68,"maximum":14.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.68,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; whirlpool ","code_information":[{"code":"97022","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":14.00,"maximum":16.80,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.00,"methodology":"fee schedule"}]}]},{"description":"Argatroban dialysis (acco ","code_information":[{"code":"9021","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.20,"maximum":5.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"}]}]},{"description":"Arsenic ","code_information":[{"code":"82175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.20,"maximum":22.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.87,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.97,"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"},{"code":"T000070801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":36.44,"maximum":45.08,"gross_charge":1146.25,"discounted_cash":1146.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":38.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":36.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":41.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37.57,"methodology":"fee schedule"}]}]},{"description":"ATXN1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score ","code_information":[{"code":"81490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":798.62,"maximum":1008.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":861.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":891.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":924.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":924.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":899.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1008.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":798.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":924.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":966.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":844.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":840.65,"methodology":"fee schedule"}]}]},{"description":"B cells, total count ","code_information":[{"code":"86355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.19,"maximum":45.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":103030.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18616.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19070.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19252.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15609.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19833.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15609.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18344.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18344.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22496.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34599.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22496.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15609.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19978.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":103030.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":42654.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":103030.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19252.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":35235.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18525.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19070.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19433.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17617.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19070.64,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19252.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22703.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15580.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19978.76,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19070.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20069.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18525.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17290.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18162.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20069.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17799.26,"methodology":"fee schedule"}]}]},{"description":"BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative ","code_information":[{"code":"81207","type":"CPT"},{"code":"L000048102","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":137.60,"maximum":173.81,"gross_charge":607.50,"discounted_cash":607.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":148.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":154.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":153.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":147.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":147.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":154.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":147.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":154.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":173.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":137.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":159.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":166.57,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":145.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":144.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":152.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":144.84,"methodology":"fee schedule"}]}]},{"description":"BEHAVIORAL AND DEVELOPMENTAL DISORDERS ","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":20859.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14165.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14510.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14648.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9411.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11957.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9411.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13957.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13957.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13563.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20859.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13563.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9411.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15201.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14648.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14096.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14510.72,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14787.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13405.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14510.72,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14648.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17274.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11676.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15201.70,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14510.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15270.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14096.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13156.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13819.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15270.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13543.34,"methodology":"fee schedule"}]}]},{"description":"Beta-2 microglobulin ","code_information":[{"code":"82232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.67,"maximum":19.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.37,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.18,"methodology":"fee schedule"}]}]},{"description":"BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH ","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":90105.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16387.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16787.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16947.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":31154.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":39583.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":31154.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16148.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16148.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":44899.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":69053.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44899.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":31154.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17587.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":90105.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37303.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":90105.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16947.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":30815.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16307.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16787.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17107.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15508.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16787.64,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16947.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19985.29,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13625.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17587.05,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16787.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17666.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16307.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15220.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15988.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17666.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15668.47,"methodology":"fee schedule"}]}]},{"description":"Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health ca ","code_information":[{"code":"90913","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.62,"maximum":37.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":32.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":30.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":36.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31.56,"methodology":"fee schedule"}]}]},{"description":"Bladder calculi irrig sol ","code_information":[{"code":"9223","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":146.92,"maximum":176.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":150.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":157.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":155.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":149.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":149.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":161.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":157.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":161.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":149.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":157.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":146.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":146.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":176.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":146.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":161.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":147.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":146.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":154.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":146.92,"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":7.04,"maximum":9.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.77,"methodology":"fee schedule"}]}]},{"description":"Blood count; reticulocyte, automated ","code_information":[{"code":"85045","type":"CPT"},{"code":"L000199801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.62,"maximum":4.79,"gross_charge":118.00,"discounted_cash":118.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.99,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each ","code_information":[{"code":"86905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.64,"maximum":4.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.83,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards o ","code_information":[{"code":"82270","type":"CPT"},{"code":"L000089801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.97,"maximum":5.26,"gross_charge":18.25,"discounted_cash":18.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.16,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.38,"methodology":"fee schedule"}]}]},{"description":"Brachytx planar, p-103 ","code_information":[{"code":"2648","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.69,"maximum":5.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.69,"methodology":"fee schedule"}]}]},{"description":"Brachytx, non-stranded,I- ","code_information":[{"code":"2639","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":34.95,"maximum":41.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34.95,"methodology":"fee schedule"}]}]},{"description":"BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s) ","code_information":[{"code":"81210","type":"CPT"},{"code":"L000048402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":166.63,"maximum":210.48,"gross_charge":735.75,"discounted_cash":735.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":179.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":187.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":185.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":192.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":187.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":192.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":178.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":187.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":210.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":166.63,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":192.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":201.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":176.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":175.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":184.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":175.40,"methodology":"fee schedule"}]}]},{"description":"BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, ","code_information":[{"code":"81162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1654.01,"maximum":2189.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1870.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1952.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1934.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2007.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1952.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2007.37,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1861.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1952.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1654.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2189.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1733.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2007.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2098.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1834.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1824.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1916.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1824.88,"methodology":"fee schedule"}]}]},{"description":"Brexucabtagene car pos t ","code_information":[{"code":"9391","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":460530.40,"maximum":552636.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":472043.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":492767.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":488162.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":469741.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":469741.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":506583.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":492767.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":506583.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":469741.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":492767.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":460530.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":460530.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":552636.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":460530.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":506583.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":529609.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":462833.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":460530.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":483556.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":460530.40,"methodology":"fee schedule"}]}]},{"description":"Busulfan injection ","code_information":[{"code":"1178","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.27,"maximum":1.52,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.27,"methodology":"fee schedule"}]}]},{"description":"CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; full gene sequence ","code_information":[{"code":"81185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":803.96,"maximum":1015.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":867.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":905.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":897.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":863.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":863.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":930.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":905.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":930.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":863.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":905.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1015.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":803.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":930.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":973.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":850.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":888.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":846.27,"methodology":"fee schedule"}]}]},{"description":"Calcium glucon (wg critic ","code_information":[{"code":"9238","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.09,"maximum":0.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.09,"methodology":"fee schedule"}]}]},{"description":"Calculus; X-ray diffraction ","code_information":[{"code":"82370","type":"CPT"},{"code":"L000091301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.35,"maximum":15.02,"gross_charge":346.50,"discounted_cash":346.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.52,"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":10.40,"maximum":12.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.72,"methodology":"fee schedule"}]}]},{"description":"Carbon dioxide (bicarbonate) ","code_information":[{"code":"82374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.42,"maximum":5.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.88,"methodology":"fee schedule"}]}]},{"description":"CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC ","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":51837.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9789.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10028.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10123.73,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9015.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11454.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9015.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9646.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9646.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12993.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19982.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12993.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9015.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10505.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":51837.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21460.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":51837.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10123.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17728.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9741.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10028.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10219.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9264.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10028.23,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10123.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11938.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7839.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10505.76,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10028.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10553.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9741.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9092.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9550.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10553.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9359.68,"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":555.65,"maximum":701.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":599.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":619.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":701.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":555.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":587.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":614.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"}]}]},{"description":"Cardiac Rehabilitation ","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":121.64,"maximum":145.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":124.68,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":128.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":124.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":124.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":133.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":133.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":124.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":121.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":121.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":145.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":121.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":133.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":139.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":122.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":121.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":127.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":121.64,"methodology":"fee schedule"}]}]},{"description":"Cardiology (cardiovascular disease), analysis of 4 proteins (NT-proBNP, osteopontin, tissue inhibitor of metalloproteinase-1 [TIMP-1], and kidney injury molecule-1 [KIM-1]), plasma, algorithm reported ","code_information":[{"code":"0309U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371.21,"maximum":468.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":400.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":414.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":468.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":371.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":449.36,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":392.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":410.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":390.75,"methodology":"fee schedule"}]}]},{"description":"Caregiver training in strategies and techniques to facilitate the patient's functional performance in the home or community (eg, activities of daily living ºADLs», instrumental ADLs ºiADLs», transfers ","code_information":[{"code":"97550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50.71,"maximum":62.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":53.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":55.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":53.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":53.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":53.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":52.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":52.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":50.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":62.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":52.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":57.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":52.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":52.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":54.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":52.28,"methodology":"fee schedule"}]}]},{"description":"Caster pin lock, each ","code_information":[{"code":"K0073","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":43.98,"maximum":54.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":48.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":46.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":46.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":49.87,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":49.87,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":46.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":43.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":54.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":49.87,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":52.14,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":45.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":45.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":47.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":45.34,"methodology":"fee schedule"}]}]},{"description":"CCND1/IGH (t(11;14)) (eg, mantle cell lymphoma) translocation analysis, major breakpoint, qualitative and quantitative, if performed ","code_information":[{"code":"81168","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.94,"maximum":248.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":212.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":219.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":211.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":221.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":248.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":196.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":228.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":238.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":208.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":207.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":217.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":207.31,"methodology":"fee schedule"}]}]},{"description":"Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (eg, ATP) ","code_information":[{"code":"86352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":123.14,"maximum":163.03,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":139.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":145.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":144.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":138.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":138.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":149.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":145.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":149.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":138.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":145.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":123.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":163.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":129.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":149.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":156.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":136.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":135.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":142.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":135.86,"methodology":"fee schedule"}]}]},{"description":"CERVICAL SPINAL FUSION WITH CC ","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":69587.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":27516.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22322.34,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":27516.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22425.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22866.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23084.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":41889.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":53234.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":41889.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21995.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21995.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":56601.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":57101.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":56601.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":41889.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23955.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28810.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23084.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":42585.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22213.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22866.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23302.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21124.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22866.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":23084.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27222.36,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18830.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23955.68,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":22866.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24064.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22213.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":52552.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20732.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21777.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24064.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21342.33,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC ","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47319.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7558.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":15492.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7742.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7816.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":21630.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":19860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16596.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":21091.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16596.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7447.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7447.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22425.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19133.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22425.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16596.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8111.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19591.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7816.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11908.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7521.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7742.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7890.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7153.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7742.95,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":11580.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7816.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9217.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10270.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8111.66,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7742.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8148.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7521.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7020.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7374.24,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8148.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7226.75,"methodology":"fee schedule"}]}]},{"description":"Chemotaxis assay, specify method ","code_information":[{"code":"86155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.49,"maximum":19.19,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.99,"methodology":"fee schedule"}]}]},{"description":"CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES ","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":1620897.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":280340.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":287178.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":289913.60,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":276238.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":276238.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":300853.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":1620897.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":671053.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":1620897.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":289913.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 13+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":554339.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":278973.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":287178.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":292648.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":265298.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":287178.57,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":289913.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":341879.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":245116.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":300853.74,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":287178.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":302221.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":278973.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":273503.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":302221.26,"methodology":"fee schedule"}]}]},{"description":"Chlorinated hydrocarbons, screen ","code_information":[{"code":"82441","type":"CPT"},{"code":"L000096301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.45,"maximum":7.21,"gross_charge":172.75,"discounted_cash":172.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.01,"methodology":"fee schedule"}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC ","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":71454.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13172.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13493.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13621.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":17700.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":22489.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":17700.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12979.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12979.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":25510.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":39233.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25510.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":17700.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14135.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":71454.94,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":29582.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":71454.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13621.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24437.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13107.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13493.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13750.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12465.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13493.35,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13621.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16063.51,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10805.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14135.89,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13493.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14200.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13107.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12233.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12850.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14200.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12593.79,"methodology":"fee schedule"}]}]},{"description":"Chromogenic substrate assay ","code_information":[{"code":"85130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.78,"maximum":14.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.89,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; additional karyotypes, each study ","code_information":[{"code":"88280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.33,"maximum":40.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":35.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":34.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":30.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":40.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":31.80,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":36.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":38.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":33.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":33.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33.47,"methodology":"fee schedule"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC ","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":27818.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5647.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5785.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5840.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11932.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15160.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11932.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5565.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5565.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17196.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26447.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17196.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11932.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6061.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":27818.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":11516.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":27818.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5840.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9513.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5620.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5785.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5895.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5344.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5785.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":5840.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6887.69,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4206.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6061.16,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":5785.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6088.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5620.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5245.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5510.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6088.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5399.95,"methodology":"fee schedule"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC ","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":29933.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6012.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6159.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6217.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12925.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16423.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12925.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5924.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5924.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18629.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":28650.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18629.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12925.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6452.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29933.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12392.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29933.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6217.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10237.08,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5983.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6159.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6276.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5689.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6159.20,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6217.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7332.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4526.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6452.49,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6159.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6481.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5983.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5584.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5865.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6481.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5748.58,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, antigen assay ","code_information":[{"code":"85301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.80,"maximum":12.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.27,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.81,"methodology":"fee schedule"}]}]},{"description":"Electrical stimulator supplies (external) for use with implantable neurostimulator, per month ","code_information":[{"code":"L8678","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":25.50,"maximum":31.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":25.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.29,"methodology":"fee schedule"}]}]},{"description":"Elevating legrest, upper hanger bracket, replacement only, each ","code_information":[{"code":"K0047","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":82.74,"maximum":102.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":87.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":91.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":90.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":87.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":87.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":93.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":91.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":93.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":87.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":91.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":85.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":85.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":82.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":102.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":85.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":93.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":98.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":85.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":85.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":89.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":85.30,"methodology":"fee schedule"}]}]},{"description":"Endomysial antibody (EMA), each immunoglobulin (Ig) class ","code_information":[{"code":"86231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.96,"maximum":14.51,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"}]}]},{"description":"Epoetin alfa, non-esrd ","code_information":[{"code":"1686","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":7.53,"maximum":9.03,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.53,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC ","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":33539.63,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6634.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19294.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6796.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6860.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10007.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12719.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10007.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6537.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6537.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13229.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":12535.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13229.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10007.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7119.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":33539.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":13885.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":33539.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6860.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11470.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6602.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6796.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6925.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6278.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6796.19,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6860.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8090.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5071.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7119.82,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6796.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7152.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6602.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6161.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6472.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7152.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6343.11,"methodology":"fee schedule"}]}]},{"description":"Ethanolamine oleate ","code_information":[{"code":"1688","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":491.68,"maximum":590.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":503.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":526.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":521.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":501.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":501.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":540.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":526.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":540.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":501.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":526.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":491.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":491.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":590.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":491.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":540.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":565.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":494.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":491.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":516.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":491.68,"methodology":"fee schedule"}]}]},{"description":"Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour ","code_information":[{"code":"92607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117.34,"maximum":145.16,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":123.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":129.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":128.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":123.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":123.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":133.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":129.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":133.07,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":123.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":129.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":120.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":120.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":117.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":145.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":120.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":133.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":139.12,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":121.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":120.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":127.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":120.97,"methodology":"fee schedule"}]}]},{"description":"Exhalation port with or without swivel used with accessories for positive airway devices, replacement only ","code_information":[{"code":"A7045","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":18.80,"maximum":23.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":21.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":21.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.38,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC ","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":204354.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":36087.75,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36967.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37320.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":40115.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":50968.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":40115.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35559.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35559.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":57814.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":88915.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":57814.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":40115.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38728.32,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":204354.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":84602.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":204354.08,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37320.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":69888.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35911.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36967.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37672.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34151.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36967.94,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":37320.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":44009.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":30902.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38728.32,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":36967.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38904.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35911.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":33517.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35207.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38904.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34503.41,"methodology":"fee schedule"}]}]},{"description":"EXTRAOCULAR PROCEDURES EXCEPT ORBIT ","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":65802.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12197.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12494.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12613.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4579.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":5818.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4579.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12018.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12018.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6600.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":10151.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6600.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4579.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13089.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":65802.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":27242.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":65802.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12613.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22504.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12137.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12494.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12732.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11542.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12494.96,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12613.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14874.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9950.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13089.96,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12494.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13149.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12137.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11328.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11899.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13149.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11661.96,"methodology":"fee schedule"}]}]},{"description":"Face tent ","code_information":[{"code":"A4619","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":2.41,"maximum":2.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.48,"methodology":"fee schedule"}]}]},{"description":"Factor ix recomb gly rebi ","code_information":[{"code":"9468","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.57,"maximum":5.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.57,"methodology":"fee schedule"}]}]},{"description":"Factor viii pegylated rec ","code_information":[{"code":"1844","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.10,"maximum":2.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.10,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.10,"methodology":"fee schedule"}]}]},{"description":"Fat or lipids, feces; qualitative ","code_information":[{"code":"82705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.63,"maximum":6.12,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.10,"methodology":"fee schedule"}]}]},{"description":"Ferritin ","code_information":[{"code":"82728","type":"CPT"},{"code":"L000114101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.36,"maximum":16.36,"gross_charge":246.50,"discounted_cash":246.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.63,"methodology":"fee schedule"}]}]},{"description":"Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood ","code_information":[{"code":"81422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":721.10,"maximum":910.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":778.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":804.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":910.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":721.10,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":872.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":762.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":797.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":759.05,"methodology":"fee schedule"}]}]},{"description":"Fetal lung maturity assessment; foam stability test ","code_information":[{"code":"83662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.14,"maximum":22.69,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.91,"methodology":"fee schedule"}]}]},{"description":"Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative ","code_information":[{"code":"85380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.22,"maximum":12.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.18,"methodology":"fee schedule"}]}]},{"description":"Fibrinolytic factors and inhibitors; plasmin ","code_information":[{"code":"85400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.98,"maximum":9.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.32,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"}]}]},{"description":"Fixed, adjustable height armrest, pair ","code_information":[{"code":"K0020","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":53.00,"maximum":65.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":57.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":55.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":55.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":60.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":60.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":55.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":53.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":65.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":60.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":62.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":54.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":54.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":57.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":54.64,"methodology":"fee schedule"}]}]},{"description":"Floxuridine injection ","code_information":[{"code":"827","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3858.03,"maximum":4629.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3954.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4128.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4089.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3935.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3935.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4243.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4128.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4243.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3935.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4128.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3858.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3858.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4629.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3858.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4243.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4436.74,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3877.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3858.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4050.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3858.03,"methodology":"fee schedule"}]}]},{"description":"Fluorescent noninfectious agent antibody; titer, each antibody ","code_information":[{"code":"86256","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.92,"maximum":14.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"FOOT PROCEDURES WITH CC ","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75460.95,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13862.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14200.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14336.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7260.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9224.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7260.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13659.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13659.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10463.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16092.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10463.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7260.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14877.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":75460.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31240.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":75460.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14336.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25807.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13795.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14200.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14471.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13118.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14200.95,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14336.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16905.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11411.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14877.18,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14200.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14944.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13795.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12875.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13524.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14944.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13254.22,"methodology":"fee schedule"}]}]},{"description":"Fosphenytoin inj pe ","code_information":[{"code":"9321","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3.20,"maximum":3.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.20,"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":139.43,"maximum":172.49,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":147.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":153.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":152.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":158.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":153.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":158.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":146.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":153.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":143.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":143.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":139.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":172.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":143.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":158.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":165.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":144.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":143.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":150.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":143.74,"methodology":"fee schedule"}]}]},{"description":"FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC ","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":136694.54,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24421.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25016.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25255.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18924.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24044.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18924.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24063.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24063.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27273.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41945.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27273.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18924.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26208.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":136694.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":56591.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":136694.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25255.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":46748.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24302.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25016.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25493.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23110.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25016.92,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":25255.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29782.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26208.20,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":25016.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26327.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24302.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22682.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23825.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26327.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23349.13,"methodology":"fee schedule"}]}]},{"description":"G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis; common variant(s) (eg, A, A-) ","code_information":[{"code":"81247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":166.07,"maximum":209.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":179.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":185.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":187.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":209.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":166.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":192.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":201.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":175.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":183.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"}]}]},{"description":"Galectin-3 ","code_information":[{"code":"82777","type":"CPT"},{"code":"L000115202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":40.11,"maximum":53.10,"gross_charge":47.25,"discounted_cash":47.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":45.36,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":48.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":48.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":47.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":40.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":53.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":48.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":50.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":44.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":44.25,"methodology":"fee schedule"}]}]},{"description":"Gammaglobulin (immunoglobulin); IgE ","code_information":[{"code":"82785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.92,"maximum":19.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.46,"methodology":"fee schedule"}]}]},{"description":"Gastric acid analysis, includes pH if performed, each specimen ","code_information":[{"code":"82930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.08,"maximum":8.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.37,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.72,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.71,"methodology":"fee schedule"}]}]},{"description":"GASTROINTESTINAL HEMORRHAGE WITH MCC ","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":78147.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14326.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14675.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14815.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10053.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12773.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10053.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14116.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14116.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14489.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22284.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14489.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10053.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15374.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":78147.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":32353.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":78147.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14815.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":26726.07,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14256.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14675.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14954.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13557.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14675.46,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14815.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17470.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11817.65,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15374.29,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14675.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15444.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14256.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13305.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13976.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15444.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13697.10,"methodology":"fee schedule"}]}]},{"description":"Gel-one ","code_information":[{"code":"1417","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":534.48,"maximum":641.38,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":547.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":571.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":566.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":545.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":545.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":587.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":571.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":587.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":545.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":571.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":534.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":534.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":641.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":534.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":587.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":614.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":537.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":534.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":561.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":534.48,"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":58.78,"maximum":72.72,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":62.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":64.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":64.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":61.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":61.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":64.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":61.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":64.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":60.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":60.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":58.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":72.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":60.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":66.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":69.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":60.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":60.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":63.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":60.60,"methodology":"fee schedule"}]}]},{"description":"GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg, nonsyndromic hearing loss) gene analysis; full gene sequence ","code_information":[{"code":"81252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":96.06,"maximum":121.34,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":103.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":108.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":107.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":103.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":103.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":111.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":108.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":111.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":103.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":108.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":101.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":101.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":121.34,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":101.12,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":96.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":111.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":116.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":101.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":101.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":106.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":101.12,"methodology":"fee schedule"}]}]},{"description":"Glucagon tolerance panel; for pheochromocytoma This panel must include the following: Catecholamines, fractionated (82384 x 2) ","code_information":[{"code":"80424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45.77,"maximum":60.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":51.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":51.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":45.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":60.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":47.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":55.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":50.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.50,"methodology":"fee schedule"}]}]},{"description":"Glucose; quantitative, blood (except reagent strip) ","code_information":[{"code":"82947","type":"CPT"},{"code":"L000118101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.56,"maximum":4.72,"gross_charge":219.50,"discounted_cash":219.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.73,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"Glycated protein ","code_information":[{"code":"82985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.19,"maximum":20.11,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.76,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin; luteinizing hormone (LH) ","code_information":[{"code":"83002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.79,"maximum":22.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.52,"methodology":"fee schedule"}]}]},{"description":"Growth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) ","code_information":[{"code":"83006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":71.82,"maximum":90.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":77.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":80.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":77.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":77.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":83.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":83.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":77.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":80.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":75.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":75.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":75.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":71.82,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":83.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":86.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":75.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":75.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":79.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":75.60,"methodology":"fee schedule"}]}]},{"description":"HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, M ","code_information":[{"code":"81257","type":"CPT"},{"code":"L000053502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":97.15,"maximum":122.71,"gross_charge":414.25,"discounted_cash":414.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":104.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":109.42,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":108.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":112.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":109.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":112.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":104.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":109.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":102.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":102.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":122.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":102.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":97.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":112.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":117.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":102.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":102.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":107.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":102.26,"methodology":"fee schedule"}]}]},{"description":"HEADACHES WITH MCC ","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":49834.49,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9444.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9674.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9766.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6931.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8806.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6931.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9305.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9305.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9989.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":15362.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9989.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6931.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10135.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49834.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20631.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49834.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9766.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17043.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9398.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9674.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9858.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8937.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9674.43,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9766.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11517.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7536.10,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10135.11,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9674.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10181.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9398.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8771.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9213.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10181.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9029.46,"methodology":"fee schedule"}]}]},{"description":"HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC ","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":1210676.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":209606.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":214719.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 28. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":216764.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 28. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":143040.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":181740.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":143040.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":206539.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":206539.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":206150.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":317048.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":206150.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":143040.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":224944.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":1210676.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":501221.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":1210676.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":216764.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 29+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":414046.08,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":208584.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":214719.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 28. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":218809.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":198359.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":214719.33,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":216764.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":255618.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":183081.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":224944.06,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":214719.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":225966.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":208584.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":204494.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":225966.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":200404.71,"methodology":"fee schedule"}]}]},{"description":"Helicobacter pylori detection and antibiotic resistance, DNA, 16S and 23S rRNA, gyrA, pbp1, rdxA and rpoB, next generation sequencing, formalin-fixed paraffin embedded or fresh tissue, predictive, rep ","code_information":[{"code":"0008U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":568.01,"maximum":717.49,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":612.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":639.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":633.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":609.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":609.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":657.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":639.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":657.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":609.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":639.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":717.49,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":568.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":657.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":687.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":600.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":627.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":597.91,"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":577.76,"maximum":729.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":623.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":644.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":729.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":577.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":699.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":611.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":638.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"}]}]},{"description":"Hematology (von Willebrand disease [VWD]), von Willebrand factor (VWF) and collagen III binding by enzyme-linked immunosorbent assays (ELISA), plasma, report of collagen III binding ","code_information":[{"code":"0279U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.95,"maximum":13.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"}]}]},{"description":"Hemin ","code_information":[{"code":"1690","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":32.20,"maximum":38.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":33.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":32.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":34.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":32.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":38.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":32.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":35.41,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":37.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":32.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":32.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":32.20,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen) ","code_information":[{"code":"82820","type":"CPT"},{"code":"L000117201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.09,"maximum":16.01,"gross_charge":277.50,"discounted_cash":277.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.34,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.34,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; plasma ","code_information":[{"code":"83051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.63,"maximum":8.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.31,"methodology":"fee schedule"}]}]},{"description":"Hemosiderin, qualitative ","code_information":[{"code":"83070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.31,"maximum":5.70,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"Hepatitis A antibody (HAAb) ","code_information":[{"code":"86708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.23,"maximum":14.87,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"Hepatitis C antibody; ","code_information":[{"code":"86803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.93,"maximum":17.12,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.27,"methodology":"fee schedule"}]}]},{"description":"Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), genomic sequence analysis panel utilizing a combination of NGS, San ","code_information":[{"code":"0102U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1238.75,"maximum":1564.74,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1336.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1395.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1382.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1330.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1330.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1434.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1395.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1434.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1330.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1395.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1303.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1303.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1564.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1303.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1238.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1434.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1499.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1310.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1303.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1369.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1303.95,"methodology":"fee schedule"}]}]},{"description":"Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at leas ","code_information":[{"code":"81436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":555.65,"maximum":701.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":599.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":619.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":701.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":555.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":587.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":614.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"}]}]},{"description":"Hereditary peripheral neuropathies (eg, Charcot-Marie-Tooth, spastic paraplegia), genomic sequence analysis panel, must include sequencing of at least 5 peripheral neuropathy-related genes (eg, BSCL2, ","code_information":[{"code":"81448","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":555.65,"maximum":701.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":599.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":619.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":625.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":701.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":555.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":643.39,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":587.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":614.14,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"}]}]},{"description":"Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney ","code_information":[{"code":"86310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.68,"maximum":8.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"}]}]},{"description":"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC ","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":125278.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":29623.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22452.78,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":29623.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":24142.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23000.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23219.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":46348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":42555.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":36700.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46638.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":36700.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22124.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22124.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":49590.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":48245.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":49590.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":36700.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24095.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":125278.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":51865.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":125278.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23219.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":42844.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22343.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23000.41,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23438.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21248.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23000.41,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":23219.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27381.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18944.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24095.67,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":23000.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24205.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22343.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":52004.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20853.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21905.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24205.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21467.05,"methodology":"fee schedule"}]}]},{"description":"HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC ","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":114042.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20515.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21015.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21215.93,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":49950.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":63465.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":49950.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20215.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20215.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":71989.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":110716.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":71989.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":49950.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22016.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":114042.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":47213.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":114042.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21215.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":39002.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20415.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21015.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21416.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19414.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21015.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":21215.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25018.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17245.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22016.53,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":21015.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22116.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20415.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19054.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20015.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22116.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19614.73,"methodology":"fee schedule"}]}]},{"description":"HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA-A, -B, and -DRB1 (eg, verification typing) ","code_information":[{"code":"81371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":366.64,"maximum":485.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":414.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":432.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":428.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":412.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":412.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":444.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":432.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":444.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":412.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":432.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":366.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":485.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":384.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":444.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":465.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":406.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":404.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":424.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":404.52,"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"}],"standard_charges":[{"setting":"outpatient","minimum":112.10,"maximum":148.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":126.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":132.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":131.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":126.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":126.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":136.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":132.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":136.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":126.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":132.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":112.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":148.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":117.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":136.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":142.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":124.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":129.86,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":123.68,"methodology":"fee schedule"}]}]},{"description":"HLA typing; lymphocyte culture, mixed (MLC) ","code_information":[{"code":"86821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33.14,"maximum":43.87,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":37.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":37.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":37.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":43.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":34.73,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":40.22,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":36.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36.56,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, fixed height, with any type side rails, without mattress ","code_information":[{"code":"E0251","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":78.05,"maximum":96.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":82.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":86.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":85.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":86.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":82.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":86.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":96.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":88.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":92.53,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":80.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":80.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":84.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":80.46,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress ","code_information":[{"code":"E0295","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":100.09,"maximum":123.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":105.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":110.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":109.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":105.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":105.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":113.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":110.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":113.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":105.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":110.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":103.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":103.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":100.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":123.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":103.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":113.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":118.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":103.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":103.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":108.35,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":103.19,"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":73.60,"maximum":91.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":80.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":77.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":77.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":83.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":83.47,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":77.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":81.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":75.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":75.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":73.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":91.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":75.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":83.47,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":87.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":76.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":75.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":79.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":75.88,"methodology":"fee schedule"}]}]},{"description":"Human Platelet Antigen 1 genotyping (HPA-1), ITGB3 (integrin, beta 3 ºplatelet glycoprotein IIIa», antigen CD61 ºGPIIIa») (eg, neonatal alloimmune thrombocytopenia ºNAIT», post-transfusion purpura), g ","code_information":[{"code":"81105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116.11,"maximum":146.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":125.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":129.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":146.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":116.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":140.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":122.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":128.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"}]}]},{"description":"Humate-P, inj ","code_information":[{"code":"1704","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.40,"maximum":1.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.43,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.40,"methodology":"fee schedule"}]}]},{"description":"Hydroxyproline; total ","code_information":[{"code":"83505","type":"CPT"},{"code":"L000126401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":22.03,"maximum":29.16,"gross_charge":228.00,"discounted_cash":228.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.30,"methodology":"fee schedule"}]}]},{"description":"Hyqvia 100mg immuneglobul ","code_information":[{"code":"1826","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":17.50,"maximum":21.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.50,"methodology":"fee schedule"}]}]},{"description":"Idursulfase injection ","code_information":[{"code":"9045","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":537.92,"maximum":645.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":551.37,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":575.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":570.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":548.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":548.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":591.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":575.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":591.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":548.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":575.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":537.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":537.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":645.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":537.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":591.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":618.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":540.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":537.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":564.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":537.92,"methodology":"fee schedule"}]}]},{"description":"Imiglucerase injection ","code_information":[{"code":"1327","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":43.62,"maximum":52.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":47.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":44.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":52.34,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":47.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":50.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":43.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":45.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43.62,"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"},{"code":"L000257401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.39,"maximum":21.71,"gross_charge":354.50,"discounted_cash":354.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.90,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.09,"methodology":"fee schedule"}]}]},{"description":"Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody ","code_information":[{"code":"86331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":14.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"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":39.36,"maximum":52.12,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":46.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":44.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":44.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":44.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":46.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":39.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":52.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":41.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":47.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":49.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":45.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":43.43,"methodology":"fee schedule"}]}]},{"description":"Infection agent detection by nucleic acid, gastrointestinal pathogens, 31 bacterial, viral, and parasitic organisms and identification of 21 associated antibiotic-resistance genes, multiplex amplified ","code_information":[{"code":"0369U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":395.94,"maximum":500.14,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":441.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":445.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":500.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":395.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":458.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":479.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":418.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":437.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":416.78,"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":"87305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":14.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"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":"87336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.50,"maximum":19.20,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.40,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.00,"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"}],"standard_charges":[{"setting":"outpatient","minimum":12.01,"maximum":15.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.25,"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"},{"code":"L000362702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":14.38,"gross_charge":126.25,"discounted_cash":126.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"Inj, bupivacaine, nos, 0. ","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.01,"maximum":0.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.01,"methodology":"fee schedule"}]}]},{"description":"Inj, clindamycin (baxter) ","code_information":[{"code":"9292","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.81,"maximum":3.38,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.89,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.81,"methodology":"fee schedule"}]}]},{"description":"Inj, dostarlimab-gxly, 10 ","code_information":[{"code":"9431","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":236.40,"maximum":283.68,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":242.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":252.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":250.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":241.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":241.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":260.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":252.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":260.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":241.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":252.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":236.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":236.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":283.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":236.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":260.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":271.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":237.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":236.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":248.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":236.40,"methodology":"fee schedule"}]}]},{"description":"Inj, factor x, (human), 1 ","code_information":[{"code":"1857","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":9.11,"maximum":10.93,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.34,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.11,"methodology":"fee schedule"}]}]},{"description":"Inj, hemgenix, per tx dos ","code_information":[{"code":"9138","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3672900.00,"maximum":4407480.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3764722.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3930003.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3893274.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3746358.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3746358.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4040190.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3930003.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4040190.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3746358.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3930003.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3672900.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3672900.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4407480.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3672900.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4040190.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4223835.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3691264.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3672900.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3856545.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3672900.00,"methodology":"fee schedule"}]}]},{"description":"Inj, lanreotide acetate ","code_information":[{"code":"9237","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":49.97,"maximum":59.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":51.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":52.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":54.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":50.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":53.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":59.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":54.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":57.47,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":50.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":49.97,"methodology":"fee schedule"}]}]},{"description":"Inj, metronidazole, 10 mg ","code_information":[{"code":"9369","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":0.03,"maximum":0.03,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":0.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":0.03,"methodology":"fee schedule"}]}]},{"description":"Inj, nusinersen, 0.1mg ","code_information":[{"code":"9489","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1231.90,"maximum":1478.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1262.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1318.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1305.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1256.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1256.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1355.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1318.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1355.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1256.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1318.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1231.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1231.90,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1478.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1231.90,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1355.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1416.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1238.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1231.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1293.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1231.90,"methodology":"fee schedule"}]}]},{"description":"Inj, pegulicianine, 1 mg ","code_information":[{"code":"772","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":37.51,"maximum":45.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":38.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":38.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":41.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":38.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":41.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37.51,"methodology":"fee schedule"}]}]},{"description":"Inj, rykindo, 0.5 mg ","code_information":[{"code":"739","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":13.03,"maximum":15.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.03,"methodology":"fee schedule"}]}]},{"description":"Inj, tebentafusp-tebn, 1 ","code_information":[{"code":"9446","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":214.76,"maximum":257.71,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":220.12,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":227.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":219.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":219.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":236.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":236.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":219.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":229.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":257.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":236.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":246.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":215.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":214.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":225.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":214.76,"methodology":"fee schedule"}]}]},{"description":"Inj, vancomycin hcl (myla ","code_information":[{"code":"9221","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5.67,"maximum":6.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.67,"methodology":"fee schedule"}]}]},{"description":"Inj. (ani), up to 40 unit ","code_information":[{"code":"9275","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3416.97,"maximum":4100.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3502.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3656.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3621.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3485.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3485.31,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3758.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3656.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3758.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3485.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3656.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4100.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3758.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3929.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3434.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3416.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3587.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3416.97,"methodology":"fee schedule"}]}]},{"description":"Inj. eptinezumab-jjmr 1 m ","code_information":[{"code":"9357","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":18.69,"maximum":22.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.69,"methodology":"fee schedule"}]}]},{"description":"Inj. lurbinectedin, 0.1 m ","code_information":[{"code":"9389","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":203.60,"maximum":244.32,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":208.69,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":217.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":215.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":223.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":217.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":223.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":207.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":217.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":203.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":203.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":244.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":203.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":223.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":234.14,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":204.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":203.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":213.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":203.60,"methodology":"fee schedule"}]}]},{"description":"Inj. romosozumab-aqqg 1 m ","code_information":[{"code":"9327","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":11.17,"maximum":13.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.17,"methodology":"fee schedule"}]}]},{"description":"Inj., bendeka 1 mg ","code_information":[{"code":"1861","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":12.95,"maximum":15.54,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"}]}]},{"description":"Inj., eravacycline, 1 mg ","code_information":[{"code":"9325","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.21,"maximum":1.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.24,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.33,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.21,"methodology":"fee schedule"}]}]},{"description":"Inj., meropenem, vaborbac ","code_information":[{"code":"9178","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.09,"maximum":2.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.09,"methodology":"fee schedule"}]}]},{"description":"Inj., tildrakizumab, 1 mg ","code_information":[{"code":"9306","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":135.92,"maximum":163.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":139.32,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":145.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":144.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":138.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":138.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":145.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":138.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":145.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":135.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":135.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":163.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":135.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":149.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":156.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":136.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":135.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":142.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":135.92,"methodology":"fee schedule"}]}]},{"description":"Injection, aducanumab-avw ","code_information":[{"code":"9438","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5.98,"maximum":7.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.98,"methodology":"fee schedule"}]}]},{"description":"Injection, cangrelor ","code_information":[{"code":"9460","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":18.82,"maximum":22.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.82,"methodology":"fee schedule"}]}]},{"description":"Injection, fulphila ","code_information":[{"code":"9173","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":135.53,"maximum":162.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":138.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":145.02,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":143.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":138.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":138.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":149.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":145.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":149.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":138.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":145.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":135.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":135.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":162.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":135.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":149.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":155.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":136.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":135.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":142.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":135.53,"methodology":"fee schedule"}]}]},{"description":"Injection, necitumumab, 1 ","code_information":[{"code":"9475","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5.73,"maximum":6.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.73,"methodology":"fee schedule"}]}]},{"description":"Injection, ramucirumab ","code_information":[{"code":"1488","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":71.07,"maximum":85.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":72.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":76.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":75.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":72.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":72.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":78.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":76.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":78.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":72.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":76.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":85.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":78.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":81.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":71.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":71.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":74.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":71.07,"methodology":"fee schedule"}]}]},{"description":"Injection,onabotulinumtox ","code_information":[{"code":"902","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":6.41,"maximum":7.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.41,"methodology":"fee schedule"}]}]},{"description":"Insulin; free ","code_information":[{"code":"83527","type":"CPT"},{"code":"L000162401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.74,"maximum":15.54,"gross_charge":354.50,"discounted_cash":354.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.95,"methodology":"fee schedule"}]}]},{"description":"Interleukin-6 (IL-6) ","code_information":[{"code":"83529","type":"CPT"},{"code":"L000162501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.66,"maximum":20.72,"gross_charge":354.50,"discounted_cash":354.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC ","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":346464.47,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":58249.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":60591.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":58249.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":47471.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":62069.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":62660.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":80010.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":101657.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":80010.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":59705.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":59705.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":115311.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":177342.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":115311.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":80010.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":65025.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":346464.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":143436.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":346464.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":62660.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 10+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":118489.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":60296.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":62069.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":63251.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":57340.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":62069.55,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":62660.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":73892.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":52393.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":65025.25,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":62069.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":65320.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":60296.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":170580.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 16. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":56276.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":59113.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":65320.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":57931.58,"methodology":"fee schedule"}]}]},{"description":"Ipilimumab injection ","code_information":[{"code":"9284","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":176.88,"maximum":212.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":181.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":189.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":187.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":180.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":180.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":194.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":189.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":194.57,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":180.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":189.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":176.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":176.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":212.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":176.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":194.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":203.42,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":177.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":176.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":185.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":176.88,"methodology":"fee schedule"}]}]},{"description":"Isocitric dehydrogenase (IDH) ","code_information":[{"code":"83570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.02,"maximum":10.62,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.85,"methodology":"fee schedule"}]}]},{"description":"Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative ","code_information":[{"code":"82009","type":"CPT"},{"code":"L000081901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.09,"maximum":5.42,"gross_charge":341.00,"discounted_cash":341.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.52,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC ","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":111076.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20004.01,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20491.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20687.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":22518.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":28611.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":22518.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19711.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19711.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":32454.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":49912.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":32454.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":22518.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21467.72,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":111076.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":45985.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":111076.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20687.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":37987.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19906.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20491.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20882.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18930.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20491.92,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":20687.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24395.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16797.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":21467.72,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":20491.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21565.30,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19906.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":65953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18579.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19516.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21565.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19125.79,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC ","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":29731.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5977.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6123.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6181.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6106.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7758.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6106.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5890.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5890.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8801.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":13535.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8801.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6106.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6415.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29731.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12308.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29731.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6181.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10167.99,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5948.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6123.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6240.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5656.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6123.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6181.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7289.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4496.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6415.11,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6123.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6444.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5948.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5551.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5831.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6444.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5715.28,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustmen ","code_information":[{"code":"L1851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":851.47,"maximum":1053.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":899.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":939.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":930.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":895.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":895.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":965.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":939.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":965.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":895.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":939.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":877.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":877.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":851.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1053.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":877.80,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":965.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1009.47,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":882.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":877.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":921.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":877.80,"methodology":"fee schedule"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC ","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":67917.44,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12562.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12868.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12991.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":17734.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":22532.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":17734.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12378.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12378.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":25558.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":39307.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":25558.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":17734.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13481.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":67917.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28117.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":67917.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12991.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":23227.47,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12500.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12868.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13113.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11888.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12868.51,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12991.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15319.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10270.65,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13481.29,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12868.51,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13542.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12500.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27850.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11667.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12255.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13542.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12010.61,"methodology":"fee schedule"}]}]},{"description":"Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation ","code_information":[{"code":"83625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.59,"maximum":15.35,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.11,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.07,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.79,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC ","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":48710.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19193.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18464.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19193.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":15641.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18914.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19095.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":24718.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":22697.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16918.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":21495.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16918.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18194.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18194.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":24383.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":37499.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":24383.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16918.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19815.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48710.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20167.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48710.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19095.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":34934.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18374.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18914.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19275.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17473.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18914.99,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19095.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22517.85,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15447.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19815.71,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18914.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19905.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18374.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17149.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18014.28,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19905.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17653.99,"methodology":"fee schedule"}]}]},{"description":"Lead wires, (e.g., apnea monitor), per pair ","code_information":[{"code":"A4557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20.41,"maximum":25.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.20,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.04,"methodology":"fee schedule"}]}]},{"description":"Leukocyte histamine release test (LHR) ","code_information":[{"code":"86343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.29,"maximum":14.95,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.46,"methodology":"fee schedule"}]}]},{"description":"Level 1 Airway Endoscopy ","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":182.34,"maximum":218.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":186.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":195.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":193.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":185.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":185.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":200.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":195.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":200.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":185.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":195.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":182.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":182.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":218.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":182.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":200.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":209.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":183.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":182.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":191.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":182.34,"methodology":"fee schedule"}]}]},{"description":"Level 1 ENT Procedures ","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":224.85,"maximum":269.83,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":230.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":240.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":238.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":229.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":229.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":247.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":240.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":247.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":229.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":240.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":224.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":224.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":269.83,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":224.85,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":247.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":258.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":225.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":224.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":236.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":224.85,"methodology":"fee schedule"}]}]},{"description":"Level 1 Intraocular Proce ","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2145.21,"maximum":2574.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2198.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2295.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2273.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2188.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2188.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2359.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2295.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2359.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2188.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2295.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2145.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2145.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2574.26,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2145.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2359.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2466.99,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2155.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2145.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2252.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2145.21,"methodology":"fee schedule"}]}]},{"description":"Level 1 Nuclear Medicine ","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":379.67,"maximum":455.61,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":389.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":402.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":387.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":387.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":387.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":406.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":455.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":417.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":436.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":381.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":379.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":398.66,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":379.67,"methodology":"fee schedule"}]}]},{"description":"Level 1 Urology and Relat ","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":227.51,"maximum":273.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":233.20,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":243.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":241.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":232.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":232.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":250.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":243.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":250.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":232.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":243.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":227.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":227.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":273.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":227.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":250.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":261.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":228.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":227.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":238.89,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":227.51,"methodology":"fee schedule"}]}]},{"description":"Level 2 Electronic Analys ","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":89.11,"maximum":106.93,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":91.34,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":95.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":94.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":98.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":95.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":98.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":90.89,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":95.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":89.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":89.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":106.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":89.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":98.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":102.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":89.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":89.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":93.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":89.11,"methodology":"fee schedule"}]}]},{"description":"Level 2 ICD and Similar P ","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":30285.23,"maximum":36342.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31042.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32405.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32102.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30890.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30890.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33313.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32405.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33313.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30890.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32405.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30285.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30285.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36342.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30285.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":33313.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34828.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30436.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30285.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31799.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30285.23,"methodology":"fee schedule"}]}]},{"description":"Level 2 Nerve Injections ","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":636.60,"maximum":763.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":652.52,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":681.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":674.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":649.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":649.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":700.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":681.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":700.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":649.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":681.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":636.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":636.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":763.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":636.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":700.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":732.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":639.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":636.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":668.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":636.60,"methodology":"fee schedule"}]}]},{"description":"Level 2 Strapping and Cas ","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":247.22,"maximum":296.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":253.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":264.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":262.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":252.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":252.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":271.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":264.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":271.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":252.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":264.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":247.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":247.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":296.67,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":247.22,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":271.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":284.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":248.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":247.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":259.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":247.22,"methodology":"fee schedule"}]}]},{"description":"Level 3 Diagnostic Tests ","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":493.40,"maximum":592.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":505.73,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":523.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":503.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":503.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":542.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":542.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":503.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":527.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":493.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":493.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":592.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":493.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":542.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":567.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":495.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":493.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":518.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":493.40,"methodology":"fee schedule"}]}]},{"description":"Level 3 Gynecologic Proce ","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":740.04,"maximum":888.05,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":758.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":791.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":784.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":754.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":754.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":814.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":791.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":814.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":754.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":791.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":740.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":740.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":888.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":740.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":814.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":851.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":743.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":740.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":777.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":740.04,"methodology":"fee schedule"}]}]},{"description":"Level 3 Nerve Injections ","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":839.06,"maximum":1006.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":860.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":897.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":889.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":855.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":855.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":922.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":897.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":922.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":855.84,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":897.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":839.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":839.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1006.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":839.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":922.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":964.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":843.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":839.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":881.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":839.06,"methodology":"fee schedule"}]}]},{"description":"Level 3 Upper GI Procedur ","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3525.48,"maximum":4230.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3613.62,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3772.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3737.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3595.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3595.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3878.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3772.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3878.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3595.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3772.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4230.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3878.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4054.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3543.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3525.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3701.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3525.48,"methodology":"fee schedule"}]}]},{"description":"Level 4 Endovascular Proc ","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":16141.93,"maximum":19370.32,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16545.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17271.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17110.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16464.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16464.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17756.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17271.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17756.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16464.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17271.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16141.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16141.93,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19370.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16141.93,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17756.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18563.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16222.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16141.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16949.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16141.93,"methodology":"fee schedule"}]}]},{"description":"Level 4 Neurostimulator a ","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":20137.52,"maximum":24165.02,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20640.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21547.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21345.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20540.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20540.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22151.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21547.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22151.27,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20540.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21547.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24165.02,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22151.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23158.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20238.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20137.52,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21144.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20137.52,"methodology":"fee schedule"}]}]},{"description":"Level 5 Airway Endoscopy ","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":6300.51,"maximum":7560.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6458.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6741.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6678.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6426.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6426.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6930.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6741.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6930.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6426.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6741.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6300.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6300.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7560.62,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6300.51,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6930.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7245.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6332.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6300.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6615.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6300.51,"methodology":"fee schedule"}]}]},{"description":"Level 5 Skin Procedures ","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3302.59,"maximum":3963.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3385.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3533.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3500.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3368.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3368.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3632.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3533.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3632.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3368.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3533.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3302.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3302.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3963.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3302.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3632.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3797.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3319.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3302.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3467.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3302.59,"methodology":"fee schedule"}]}]},{"description":"Level 7 Urology and Relat ","code_information":[{"code":"5377","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":11816.94,"maximum":14180.33,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12112.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12644.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12525.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12053.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12053.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12998.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12644.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12998.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12053.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12644.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11816.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11816.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14180.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11816.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12998.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13589.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11876.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11816.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12407.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11816.94,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein (a) ","code_information":[{"code":"83695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.98,"maximum":17.18,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.60,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.04,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.32,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, direct measurement; VLDL cholesterol ","code_information":[{"code":"83719","type":"CPT"},{"code":"L000166701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.55,"maximum":15.30,"gross_charge":324.50,"discounted_cash":324.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.66,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.75,"methodology":"fee schedule"}]}]},{"description":"LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT ","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":457708.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":79773.45,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":81719.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 14. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":82497.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 14. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":127068.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":161446.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":127068.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":78606.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":78606.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":183131.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":281645.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":183131.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":127068.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":85610.54,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":457708.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":189491.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":457708.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":82497.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 15+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":156534.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":79384.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":81719.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 14. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":83275.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":75492.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":81719.15,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":82497.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":97284.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":69215.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":85610.54,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":81719.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":85999.67,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":79384.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":77827.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":85999.67,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":76271.20,"methodology":"fee schedule"}]}]},{"description":"Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day ","code_information":[{"code":"97610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":402.43,"maximum":482.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":412.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":430.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":426.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":410.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":410.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":442.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":430.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":442.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":410.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":430.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":482.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":442.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":462.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":404.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":402.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":422.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":402.43,"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":954.64,"maximum":1181.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1008.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1053.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1043.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1003.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1003.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1082.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1053.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1082.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1003.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1053.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":984.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":984.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":954.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1181.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":984.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1082.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1131.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":989.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":984.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1033.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":984.17,"methodology":"fee schedule"}]}]},{"description":"Lutetium lu 177 dotatat t ","code_information":[{"code":"9067","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":296.25,"maximum":355.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":303.66,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":316.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":314.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":302.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":302.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":325.87,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":316.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":325.87,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":302.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":316.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":296.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":296.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":355.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":296.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":325.87,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":340.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":297.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":296.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":311.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":296.25,"methodology":"fee schedule"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":49155.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9326.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9554.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9645.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14284.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18149.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14284.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9190.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9190.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":20586.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":31661.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20586.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14284.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10009.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49155.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20350.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49155.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9645.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16810.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9281.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9554.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9736.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8826.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9554.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9645.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11374.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7433.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10009.44,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9554.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10054.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9281.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8662.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9099.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10054.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8917.50,"methodology":"fee schedule"}]}]},{"description":"Macroscopic examination; arthropod ","code_information":[{"code":"87168","type":"CPT"},{"code":"L000347401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.87,"maximum":5.12,"gross_charge":121.25,"discounted_cash":121.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.27,"methodology":"fee schedule"}]}]},{"description":"MAJOR CHEST PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":80116.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14665.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15023.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15166.27,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":32994.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":41921.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":32994.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14450.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14450.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":47552.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":73132.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":47552.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":32994.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15738.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":80116.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":33168.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":80116.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15166.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":27399.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14593.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15023.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15309.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13878.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15023.19,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15166.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17884.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12115.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15738.58,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15023.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15810.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14593.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13621.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14307.80,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15810.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14021.64,"methodology":"fee schedule"}]}]},{"description":"MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC ","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75147.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13808.73,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14145.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14280.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14824.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18834.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14824.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13606.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13606.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":21364.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":32857.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21364.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14824.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14819.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":75147.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31111.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":75147.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14280.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25700.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13741.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14145.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14414.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13067.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14145.53,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14280.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16839.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11363.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14819.12,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14145.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14886.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13741.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12825.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13471.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14886.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13202.49,"methodology":"fee schedule"}]}]},{"description":"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC ","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":76544.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":29623.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25075.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":29623.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":24142.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25687.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25931.96,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":46348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":42555.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":36700.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46638.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":36700.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24708.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24708.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":49590.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":48245.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":49590.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":36700.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26910.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31691.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25931.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":48046.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24953.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25687.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26176.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23730.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25687.32,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":25931.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30580.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21245.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26910.52,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":25687.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":27032.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24953.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":52004.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23289.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24464.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":27032.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23974.83,"methodology":"fee schedule"}]}]},{"description":"MAJOR SKIN DISORDERS WITHOUT MCC ","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":46464.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8863.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9079.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9165.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8832.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11222.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8832.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8733.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8733.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12729.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19577.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12729.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8832.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9511.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46464.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19236.40,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":46464.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9165.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15890.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8819.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9079.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9252.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8387.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9079.19,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9165.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10808.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7026.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9511.53,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9079.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9554.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8819.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8231.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8646.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9554.77,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8473.91,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC ","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":78422.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14373.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14724.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14864.28,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11455.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14554.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11455.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14163.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14163.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16509.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":25391.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16509.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11455.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15425.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":78422.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":32466.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":78422.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14864.28,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":26820.15,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14303.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14724.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15004.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13602.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14724.06,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14864.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17528.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11859.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15425.20,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14724.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15495.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14303.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13349.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14022.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15495.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13742.45,"methodology":"fee schedule"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITH CC ","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":46374.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8847.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9063.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9149.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11487.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14595.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11487.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8717.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8717.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16556.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":25462.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16556.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11487.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9494.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":46374.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19199.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":46374.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9149.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15859.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8804.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9063.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9235.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8372.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9063.25,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9149.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10789.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7012.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9494.83,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9063.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9537.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8804.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8217.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8631.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9537.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8459.03,"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":49.73,"maximum":61.52,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":52.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":52.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":49.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.27,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":56.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.27,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, foam propulsion tire, any size, each ","code_information":[{"code":"E2218","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":53.19,"maximum":65.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.21,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":58.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":55.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":53.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":65.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":60.32,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":63.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":55.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":54.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":57.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":54.84,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches ","code_information":[{"code":"E2201","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":435.82,"maximum":539.16,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":460.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":480.75,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":476.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":458.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":458.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":480.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":458.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":480.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":449.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":449.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":435.82,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":539.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":449.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":494.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":516.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":451.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":449.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":471.77,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":449.30,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, solid seat insert ","code_information":[{"code":"E0992","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":109.57,"maximum":135.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":115.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":119.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":115.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":115.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":124.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":124.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":115.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":112.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":112.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":109.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":135.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":112.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":124.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":129.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":113.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":112.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":118.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":112.96,"methodology":"fee schedule"}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITH CC/MCC ","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":75267.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13829.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14166.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14301.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11779.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14965.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11779.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13627.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13627.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16976.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26108.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16976.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11779.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14841.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":75267.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31160.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":75267.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14301.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25741.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13762.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14166.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14436.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13087.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14166.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14301.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16865.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11382.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14841.39,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14166.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14908.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13762.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12844.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13492.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14908.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13222.33,"methodology":"fee schedule"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; duplication/deletion variants ","code_information":[{"code":"81304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":142.50,"maximum":180.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":153.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":159.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":160.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":180.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":142.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":165.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":172.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":150.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":157.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":150.00,"methodology":"fee schedule"}]}]},{"description":"Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes ","code_information":[{"code":"97802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.04,"maximum":36.05,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":34.28,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":33.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.04,"methodology":"fee schedule"}]}]},{"description":"Methemalbumin ","code_information":[{"code":"83857","type":"CPT"},{"code":"L000169101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":9.74,"maximum":12.89,"gross_charge":297.50,"discounted_cash":297.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"Minocycline hydrochloride ","code_information":[{"code":"1853","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.59,"maximum":3.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.59,"methodology":"fee schedule"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":53522.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10079.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10325.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10424.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12180.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15475.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12180.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9932.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9932.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17554.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26997.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17554.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12180.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10817.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":53522.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22158.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":53522.43,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10424.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18304.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10030.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10325.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10522.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9539.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10325.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10424.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12292.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8093.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10817.55,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10325.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10866.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10030.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9362.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9834.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10866.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9637.46,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants ","code_information":[{"code":"81294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192.28,"maximum":242.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":216.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":214.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":206.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":206.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":222.64,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":216.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":222.64,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":206.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":216.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":202.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":202.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":242.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":202.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":192.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":222.64,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":232.76,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":203.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":202.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":212.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":202.40,"methodology":"fee schedule"}]}]},{"description":"Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells ","code_information":[{"code":"88275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46.40,"maximum":61.43,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":46.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":48.63,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.19,"methodology":"fee schedule"}]}]},{"description":"Molecular pathology procedure, Level 7 (eg, analysis of 11-25 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 26-50 exons) ACADVL (acyl-CoA dehydrogenase, very lo ","code_information":[{"code":"81406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":268.74,"maximum":339.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":339.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":268.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":325.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":284.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"MOUTH PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":34966.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6880.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7048.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7115.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7291.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9263.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7291.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6779.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6779.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10508.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16161.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10508.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7291.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7383.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":34966.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14476.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":34966.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7115.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11958.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6846.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7048.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7182.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6511.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7048.26,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7115.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8390.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5287.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7383.89,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7048.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7417.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6846.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6390.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6712.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7417.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6578.37,"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":320.84,"maximum":405.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":346.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":357.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":344.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":344.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":371.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":371.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":344.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":361.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":405.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":320.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":371.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":388.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":339.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":354.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":337.73,"methodology":"fee schedule"}]}]},{"description":"Mucoprotein, blood (seromucoid) (medical necessity procedure) ","code_information":[{"code":"P2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.49,"maximum":5.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"}]}]},{"description":"MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC ","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":52589.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9919.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10161.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10257.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10848.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13783.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10848.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9774.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9774.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":15634.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24045.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":15634.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10848.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10644.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52589.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21772.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52589.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10257.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17985.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9870.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10161.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10354.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9386.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10161.09,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10257.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12096.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7952.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10644.95,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10161.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10693.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9870.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9212.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9677.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10693.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9483.69,"methodology":"fee schedule"}]}]},{"description":"Myelin basic protein, cerebrospinal fluid ","code_information":[{"code":"83873","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.59,"maximum":20.64,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.20,"methodology":"fee schedule"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCE ","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":62858.34,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11689.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11974.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12088.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11635.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14782.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11635.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11518.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11518.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16768.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":25789.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16768.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11635.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12545.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":62858.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":26023.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":62858.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12088.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":21497.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11632.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11974.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12202.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11062.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11974.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12088.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14255.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9505.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12545.13,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11974.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12602.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11632.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10857.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11404.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12602.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11176.57,"methodology":"fee schedule"}]}]},{"description":"Natural killer (NK) cells, total count ","code_information":[{"code":"86357","type":"CPT"},{"code":"L000268801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":34.19,"maximum":45.28,"gross_charge":1026.50,"discounted_cash":1026.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":38.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":38.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":40.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":34.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":45.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":35.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":41.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":43.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":37.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":39.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":37.73,"methodology":"fee schedule"}]}]},{"description":"Nelarabine injection ","code_information":[{"code":"825","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":72.53,"maximum":87.03,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":74.34,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":77.60,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":76.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":73.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":73.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":79.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":77.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":79.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":73.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":77.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":72.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":72.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":87.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":72.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":79.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":83.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":72.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":72.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":76.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":72.53,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid organ), DNA, comprehensive genomic profiling, 257 genes, interrogation for single-nucleotide variants, insertions/deletions, copy number alterations, gene rearrangements, tumor-mutatio ","code_information":[{"code":"0244U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3325.00,"maximum":4200.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3587.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3745.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3710.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3570.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3570.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3850.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3745.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3850.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3570.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3745.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3500.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3500.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4200.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3500.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3325.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3850.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4025.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3517.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3500.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3675.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3500.00,"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":3420.00,"maximum":4320.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3690.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3816.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3852.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4320.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3420.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3960.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4140.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3618.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3600.00,"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":722.00,"maximum":912.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":779.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":722.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Oncology, RNA, gene expression by whole transcriptome sequencing, formalin-fixed paraffin embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic age ","code_information":[{"code":"0019U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3491.25,"maximum":4410.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3766.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3932.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3895.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3748.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3748.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4042.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3932.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4042.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3748.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3932.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3675.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3675.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4410.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3675.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3491.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4042.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4226.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3693.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3675.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3858.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3675.00,"methodology":"fee schedule"}]}]},{"description":"Oral methotrexate (xatmep ","code_information":[{"code":"756","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":20.71,"maximum":24.85,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.71,"methodology":"fee schedule"}]}]},{"description":"Orth/matrx/bn fill drug-e ","code_information":[{"code":"2043","type":"APC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_percentage":38.27,"standard_charge_algorithm":"Reimbursement will be 38.27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_percentage":43.32,"standard_charge_algorithm":"Reimbursement will be 43.32% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_percentage":41.52,"standard_charge_algorithm":"Reimbursement will be 41.52% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_percentage":36.28,"standard_charge_algorithm":"Reimbursement will be 36.28% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_percentage":37.91,"standard_charge_algorithm":"Reimbursement will be 37.91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Osmolality; urine ","code_information":[{"code":"83935","type":"CPT"},{"code":"L000172001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.18,"maximum":8.18,"gross_charge":75.00,"discounted_cash":75.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.82,"methodology":"fee schedule"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC ","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":108966.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19640.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20119.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20310.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":3840.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":4879.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":3840.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19352.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19352.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":5535.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":8512.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":5535.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":3840.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21077.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":108966.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":45112.10,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":108966.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20310.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":37265.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19544.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20119.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20502.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18586.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20119.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":20310.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23951.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16478.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":21077.19,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":20119.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21172.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19544.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18241.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19161.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21172.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18777.86,"methodology":"fee schedule"}]}]},{"description":"OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC ","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":92559.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16811.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17221.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17385.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12366.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15712.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12366.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16565.11,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16565.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17822.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27410.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17822.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12366.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18041.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":92559.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":38319.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":92559.59,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17385.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31654.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16729.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17221.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17549.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15909.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17221.15,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17385.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20501.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13997.10,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18041.21,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17221.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18123.22,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16729.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15613.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16401.10,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18123.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16073.08,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":58241.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10893.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11159.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11265.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25813.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":32797.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25813.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10734.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10734.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":37202.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":57214.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":37202.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25813.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11690.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":58241.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24112.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":58241.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11265.75,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19918.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10840.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11159.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11372.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10309.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11159.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11265.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13285.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8807.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11690.88,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11159.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11744.02,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10840.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10117.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10628.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11744.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10415.51,"methodology":"fee schedule"}]}]},{"description":"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":28901.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5834.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5976.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6033.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5779.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7343.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5779.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5749.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5749.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8329.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":12811.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8329.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5779.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6261.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":28901.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":11965.36,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":28901.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6033.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9884.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5806.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5976.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6090.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5521.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5976.98,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6033.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7115.46,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4370.60,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6261.60,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":5976.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6290.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5806.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5419.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5692.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6290.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5578.52,"methodology":"fee schedule"}]}]},{"description":"OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC ","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":48731.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":39302.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18005.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":39302.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":32029.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18445.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18620.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41567.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":38165.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":23918.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17742.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17742.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27131.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41726.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27131.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19323.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48731.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20176.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48731.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18620.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":34024.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17918.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18445.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18796.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17039.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18445.03,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":18620.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21958.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15044.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19323.37,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18445.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19411.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17918.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":42990.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16723.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17566.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19411.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17215.37,"methodology":"fee schedule"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC ","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":45132.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8633.26,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8843.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8928.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14632.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18591.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14632.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8506.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8506.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":21088.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":32432.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":21088.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14632.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9264.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":45132.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":18684.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":45132.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8928.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15435.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8591.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8843.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9012.28,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8170.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8843.83,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8928.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10528.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6825.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9264.96,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8843.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9307.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8591.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8018.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8422.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9307.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8254.24,"methodology":"fee schedule"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC ","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":99217.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17959.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18397.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18572.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":30734.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":39049.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":30734.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17696.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17696.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":44294.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":68122.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44294.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":30734.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19273.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":99217.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":41076.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":99217.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18572.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":33932.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17871.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18397.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18747.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16995.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18397.21,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":18572.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21901.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15003.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19273.27,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":18397.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":19360.87,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17871.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16680.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17521.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19360.87,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17170.73,"methodology":"fee schedule"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC ","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":79750.66,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14602.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14958.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15101.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9056.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11506.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9056.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14388.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14388.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13052.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20073.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13052.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9056.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15670.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":79750.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":33016.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":79750.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15101.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":27274.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14531.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14958.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15243.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13818.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14958.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15101.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17807.92,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12060.10,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15670.97,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14958.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15742.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14531.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13562.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14246.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15742.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13961.41,"methodology":"fee schedule"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC ","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":43825.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8407.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8613.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8695.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7746.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9842.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7746.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8284.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8284.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11164.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17170.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11164.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7746.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9023.17,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":43825.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":18143.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":43825.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8695.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":14988.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8366.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8613.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8777.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7956.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8613.03,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8695.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10253.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6627.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9023.17,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8613.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9064.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8366.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7809.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8202.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9064.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8038.82,"methodology":"fee schedule"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES ","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35963.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7052.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7224.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7293.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9954.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12647.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9954.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6949.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6949.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14345.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22063.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14345.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9954.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7568.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35963.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14889.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35963.88,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7293.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12299.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7017.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7224.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7362.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6673.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7224.40,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7293.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8600.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5438.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7568.41,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7224.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7602.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7017.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6550.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6880.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7602.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6742.77,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC ","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":154076.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27418.49,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28087.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28354.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12066.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15330.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12066.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27017.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27017.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17389.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26744.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17389.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12066.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29424.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":154076.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":63787.96,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":154076.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28354.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":52693.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27284.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28087.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28622.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25947.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28087.24,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":28354.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":33437.19,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23299.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29424.73,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":28087.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":29558.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27284.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25465.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26749.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29558.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26214.76,"methodology":"fee schedule"}]}]},{"description":"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC ","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":140085.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25006.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25615.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25859.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12559.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15957.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12559.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24640.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24640.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18100.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27837.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18100.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12559.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26835.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":140085.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":57995.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":140085.90,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25859.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":47908.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24884.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25615.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26103.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23664.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25615.95,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":25859.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30495.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21184.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26835.75,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":25615.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":26957.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24884.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23225.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24396.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26957.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23908.22,"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":11.51,"maximum":15.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.60,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.70,"methodology":"fee schedule"}]}]},{"description":"Paclitaxel (american rege ","code_information":[{"code":"9152","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":14.79,"maximum":17.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.09,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.79,"methodology":"fee schedule"}]}]},{"description":"PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) mRNA sequence analysis (List separately in additional to code for primary procedure) ","code_information":[{"code":"0137U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":268.74,"maximum":339.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":289.95,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":302.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":339.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":268.74,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":311.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":325.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":284.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"Parenteral infusion pump, stationary, single or multi-channel ","code_information":[{"code":"E0791","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":346.35,"maximum":428.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":365.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":382.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":378.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":364.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":364.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":392.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":382.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":392.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":364.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":382.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":346.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":428.47,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":392.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":410.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":358.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":357.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":374.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":357.06,"methodology":"fee schedule"}]}]},{"description":"Pathogen reduced plasma s ","code_information":[{"code":"9535","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":231.58,"maximum":277.90,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":237.37,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":247.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":245.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":236.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":236.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":254.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":247.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":254.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":236.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":247.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":231.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":231.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":277.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":231.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":254.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":266.32,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":232.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":231.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":243.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":231.58,"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":440.57,"maximum":556.51,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":475.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":496.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":491.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":473.04,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":473.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":510.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":496.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":510.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":473.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":496.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":556.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":440.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":510.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":533.32,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":466.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":486.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":463.76,"methodology":"fee schedule"}]}]},{"description":"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC ","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":58668.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9847.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10087.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10183.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":26469.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":33630.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":26469.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9703.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9703.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":38147.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58668.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":38147.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":26469.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10567.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":52172.77,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":21599.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":52172.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10183.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17842.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9799.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10087.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10279.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9318.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10087.45,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10183.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12008.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7889.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10567.80,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10087.45,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10615.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9799.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9145.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9607.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10615.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9414.95,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC ","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":48731.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":39302.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23981.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":39302.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":32029.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24565.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24799.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41567.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":38165.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":23918.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23630.09,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23630.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27131.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41726.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27131.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18825.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25735.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48731.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20176.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48731.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24799.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":45875.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":23864.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24565.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25033.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22694.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24565.94,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":24799.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29245.16,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":20285.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":25735.74,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":24565.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25852.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23864.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":44069.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22273.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23396.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25852.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22928.21,"methodology":"fee schedule"}]}]},{"description":"CLOSURE OF AORTICO-LEFT VENTRICULAR TUNNEL UNSCHEDULED","code_information":[{"code":"33722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Closure of atrioventricular valve (mitral or tricuspid) by suture or patch SCHEDULED","code_information":[{"code":"33600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Closure of chest wall following open flap drainage for empyema (Clagett type procedure) SCHEDULED","code_information":[{"code":"32810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2166.30,"maximum":2407.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2286.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2166.30,"methodology":"fee schedule"}]}]},{"description":"Closure of laceration, vestibule of mouth; over 2.5 cm or complex UNSCHEDULED","code_information":[{"code":"40831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120.60,"maximum":134.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":134.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":127.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":120.60,"methodology":"fee schedule"}]}]},{"description":"Closure of multiple ventricular septal defects; SCHEDULED","code_information":[{"code":"33675","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; abdominal approach UNSCHEDULED","code_information":[{"code":"50525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"Closure of rectourethral fistula; with colostomy UNSCHEDULED","code_information":[{"code":"45825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Closure of single ventricular septal defect, with or without patch; UNSCHEDULED","code_information":[{"code":"33681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure) UNSCHEDULED","code_information":[{"code":"53520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6759.90,"maximum":7511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7135.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6759.90,"methodology":"fee schedule"}]}]},{"description":"Closure of vesicovaginal fistula, abdominal approach UNSCHEDULED","code_information":[{"code":"51900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Closure of vesicovaginal fistula; transvesical and vaginal approach SCHEDULED","code_information":[{"code":"57330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor VIII (AHG), 1-stage UNSCHEDULED","code_information":[{"code":"85240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.70,"maximum":23.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":23.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":20.70,"methodology":"fee schedule"}]}]},{"description":"CNBP (CCHC-type zinc finger nucleic acid binding protein) (eg, myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (eg, expanded) alleles UNSCHEDULED","code_information":[{"code":"81187","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Coagulation/fibrinolysis assay, whole blood (eg, viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day UNSCHEDULED","code_information":[{"code":"85396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":260.10,"maximum":289.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":289.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":274.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":260.10,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial, with removal of terminal ileum with ileocolostomy SCHEDULED","code_information":[{"code":"44160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; abdominal and transanal approach UNSCHEDULED","code_information":[{"code":"44147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure) UNSCHEDULED","code_information":[{"code":"44143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed SCHEDULED","code_information":[{"code":"44158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre-and post-dilation and guide wire passage, when performed) SCHEDULED","code_information":[{"code":"44401","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps SCHEDULED","code_information":[{"code":"44392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) SCHEDULED","code_information":[{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1777.50,"maximum":1975.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1975.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1876.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1777.50,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) UNSCHEDULED","code_information":[{"code":"45378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1092.60,"maximum":1214.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1214.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1153.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1092.60,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) SCHEDULED","code_information":[{"code":"45398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with biopsy, single or multiple UNSCHEDULED","code_information":[{"code":"45380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2844.00,"maximum":3160.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3160.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3002.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2844.00,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with control of bleeding, any method UNSCHEDULED","code_information":[{"code":"45382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed UNSCHEDULED","code_information":[{"code":"45393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, desc SCHEDULED","code_information":[{"code":"45392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Colorectal cancer screening; flexible sigmoidoscopy SCHEDULED","code_information":[{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":57.60,"maximum":64.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":64.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":60.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":57.60,"methodology":"fee schedule"}]}]},{"description":"Colpocleisis (Le Fort type) SCHEDULED","code_information":[{"code":"57120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation UNSCHEDULED","code_information":[{"code":"74330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":700.20,"maximum":778.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":778.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":739.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":700.20,"methodology":"fee schedule"}]}]},{"description":"Combined rapid anterior pituitary evaluation panel This panel must include the following: Adrenocorticotropic hormone (ACTH) (82024 x 4) Luteinizing hormone (LH) (83002 x 4) Follicle stimulating hormo UNSCHEDULED","code_information":[{"code":"80418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118.80,"maximum":132.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":132.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":125.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":118.80,"methodology":"fee schedule"}]}]},{"description":"COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES UNSCHEDULED","code_information":[{"code":"93531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10276.20,"maximum":11418.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11418.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10847.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":10276.20,"methodology":"fee schedule"}]}]},{"description":"Comp unusual REP >7.5 cm SCHEDULED","code_information":[{"code":"13300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2364.30,"maximum":2627.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2627.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2364.30,"methodology":"fee schedule"}]}]},{"description":"Complement; total hemolytic (CH50) UNSCHEDULED","code_information":[{"code":"86162","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Complete repair tetralogy of Fallot with pulmonary atresia including construction of conduit from right ventricle to pulmonary artery and closure of ventricular septal defect UNSCHEDULED","code_information":[{"code":"33697","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Complete repair tetralogy of Fallot without pulmonary atresia; UNSCHEDULED","code_information":[{"code":"33692","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile) UNSCHEDULED","code_information":[{"code":"51729","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and reco UNSCHEDULED","code_information":[{"code":"93620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11405.70,"maximum":12673.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":12673.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":12039.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":11405.70,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material UNSCHEDULED","code_information":[{"code":"74261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":700.20,"maximum":778.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":778.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":739.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":700.20,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing UNSCHEDULED","code_information":[{"code":"71275","type":"CPT"},{"code":"I000072401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2688.30,"maximum":2987.00,"gross_charge":10301.50,"discounted_cash":10301.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2987.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2837.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2688.30,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing UNSCHEDULED","code_information":[{"code":"70496","type":"CPT"},{"code":"I000066201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3226.50,"maximum":3585.00,"gross_charge":11536.75,"discounted_cash":11536.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3585.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3405.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3226.50,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material UNSCHEDULED","code_information":[{"code":"74176","type":"CPT"},{"code":"I000127701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3474.00,"maximum":3860.00,"gross_charge":20600.00,"discounted_cash":20600.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3860.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3667.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3474.00,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; with contrast material(s) UNSCHEDULED","code_information":[{"code":"74160","type":"CPT"},{"code":"I000126901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2497.50,"maximum":2775.00,"gross_charge":10919.00,"discounted_cash":10919.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2775.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2636.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2497.50,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections UNSCHEDULED","code_information":[{"code":"74170","type":"CPT"},{"code":"I000127101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6985.80,"maximum":7762.00,"gross_charge":11536.75,"discounted_cash":11536.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7762.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7373.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6985.80,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material UNSCHEDULED","code_information":[{"code":"70480","type":"CPT"},{"code":"I000063701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2045.70,"maximum":2273.00,"gross_charge":10301.50,"discounted_cash":10301.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2273.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2159.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2045.70,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections UNSCHEDULED","code_information":[{"code":"70492","type":"CPT"},{"code":"I000065301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5961.60,"maximum":6624.00,"gross_charge":11536.75,"discounted_cash":11536.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6624.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6292.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5961.60,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections UNSCHEDULED","code_information":[{"code":"71270","type":"CPT"},{"code":"I000072001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2473.20,"maximum":2748.00,"gross_charge":10301.50,"discounted_cash":10301.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2748.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2610.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2473.20,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections UNSCHEDULED","code_information":[{"code":"73202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8043.30,"maximum":8937.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8937.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8490.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8043.30,"methodology":"fee schedule"}]}]},{"description":"Computer-assisted surgical navigational procedure for musculoskeletal procedures, image-less (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"20985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), incl UNSCHEDULED","code_information":[{"code":"92549","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":836.10,"maximum":929.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":929.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":882.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":836.10,"methodology":"fee schedule"}]}]},{"description":"Conjunctival flap; bridge or partial (separate procedure) SCHEDULED","code_information":[{"code":"68360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1697.40,"maximum":1886.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1886.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1791.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1697.40,"methodology":"fee schedule"}]}]},{"description":"Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft (includes obtaining graft) SCHEDULED","code_information":[{"code":"68328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1697.40,"maximum":1886.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1886.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1791.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1697.40,"methodology":"fee schedule"}]}]},{"description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; UNSCHEDULED","code_information":[{"code":"67880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239.30,"maximum":1377.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1377.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1239.30,"methodology":"fee schedule"}]}]},{"description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; with transposition of tarsal plate SCHEDULED","code_information":[{"code":"67882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4772.70,"maximum":5303.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5303.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5037.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4772.70,"methodology":"fee schedule"}]}]},{"description":"Continent ileostomy (Kock procedure) (separate procedure) UNSCHEDULED","code_information":[{"code":"44316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately UNSCHEDULED","code_information":[{"code":"95941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":489.60,"maximum":544.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":544.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":516.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":489.60,"methodology":"fee schedule"}]}]},{"description":"Continuous positive airway pressure ventilation (CPAP), initiation and management UNSCHEDULED","code_information":[{"code":"94660","type":"CPT"},{"code":"R000004901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":570.60,"maximum":634.00,"gross_charge":2002.00,"discounted_cash":2002.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":634.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":602.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":570.60,"methodology":"fee schedule"}]}]},{"description":"Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure) SCHEDULED","code_information":[{"code":"49424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"CONTRAST XRAY EXAM BILE DUCT UNSCHEDULED","code_information":[{"code":"75980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1989.00,"maximum":2210.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2210.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2099.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1989.00,"methodology":"fee schedule"}]}]},{"description":"Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method SCHEDULED","code_information":[{"code":"30903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft UNSCHEDULED","code_information":[{"code":"27132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Copper UNSCHEDULED","code_information":[{"code":"82525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts SCHEDULED","code_information":[{"code":"33535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"33523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, vein only; single coronary venous graft SCHEDULED","code_information":[{"code":"33510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Corpora cavernosography, radiological supervision and interpretation UNSCHEDULED","code_information":[{"code":"74445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1167.30,"maximum":1297.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1297.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1232.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1167.30,"methodology":"fee schedule"}]}]},{"description":"CORRECTION OF BUNION SCHEDULED","code_information":[{"code":"28290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Correction of trichiasis; incision of lid margin UNSCHEDULED","code_information":[{"code":"67830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239.30,"maximum":1377.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1377.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1239.30,"methodology":"fee schedule"}]}]},{"description":"Correction of trichiasis; incision of lid margin, with free mucous membrane graft UNSCHEDULED","code_information":[{"code":"67835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239.30,"maximum":1377.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1377.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1239.30,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method SCHEDULED","code_information":[{"code":"28299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method UNSCHEDULED","code_information":[{"code":"28299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method SCHEDULED","code_information":[{"code":"28297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2780.10,"maximum":3089.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3089.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2934.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2780.10,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal metatarsal osteotomy, any method UNSCHEDULED","code_information":[{"code":"28295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method SCHEDULED","code_information":[{"code":"28292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method UNSCHEDULED","code_information":[{"code":"28292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) SCHEDULED","code_information":[{"code":"28285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3851.10,"maximum":4279.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4065.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3851.10,"methodology":"fee schedule"}]}]},{"description":"Corticosterone UNSCHEDULED","code_information":[{"code":"82528","type":"CPT"},{"code":"L000098101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"gross_charge":610.75,"discounted_cash":610.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Counseling visit to discuss need for lung cancer screening using low dose ct scan (ldct) (service is for eligibility determination and shared decision making) SCHEDULED","code_information":[{"code":"G0296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27.90,"maximum":31.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":31.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":27.90,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural UNSCHEDULED","code_information":[{"code":"61314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural SCHEDULED","code_information":[{"code":"61312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma; without lobectomy UNSCHEDULED","code_information":[{"code":"61322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial UNSCHEDULED","code_information":[{"code":"61320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa) UNSCHEDULED","code_information":[{"code":"61305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, suboccipital with cervical laminectomy for decompression of medulla and spinal cord, with or without dural graft (eg, Arnold-Chiari malformation) SCHEDULED","code_information":[{"code":"61343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, suboccipital; for exploration or decompression of cranial nerves UNSCHEDULED","code_information":[{"code":"61458","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial SCHEDULED","code_information":[{"code":"61514","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniofacial approach to anterior cranial fossa; extradural, including lateral rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or maxillectomy UNSCHEDULED","code_information":[{"code":"61581","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter UNSCHEDULED","code_information":[{"code":"62146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea UNSCHEDULED","code_information":[{"code":"62100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic focus, with electrocorticography during surgery (includes removal of electrode array) UNSCHEDULED","code_information":[{"code":"61536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for excision of epileptogenic focus without electrocorticography during surgery SCHEDULED","code_information":[{"code":"61534","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for lobectomy, other than temporal lobe, partial or total, with electrocorticography during surgery UNSCHEDULED","code_information":[{"code":"61539","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Craniotomy with elevation of bone flap; for transection of corpus callosum UNSCHEDULED","code_information":[{"code":"61541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"CREATE SALIVARY CYST DRAIN SCHEDULED","code_information":[{"code":"42325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"CREATE SALIVARY CYST DRAIN SCHEDULED","code_information":[{"code":"42326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract SCHEDULED","code_information":[{"code":"61791","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including laminectomy SCHEDULED","code_information":[{"code":"63740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy SCHEDULED","code_information":[{"code":"63741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Cricotracheal resection UNSCHEDULED","code_information":[{"code":"31592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Cross-over vein graft to venous system UNSCHEDULED","code_information":[{"code":"34520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Cryotherapy (CO2 slush, liquid N2) for acne SCHEDULED","code_information":[{"code":"17340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis; full gene sequence UNSCHEDULED","code_information":[{"code":"81189","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Cult NEC-commercial kit UNSCHEDULED","code_information":[{"code":"87072","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89.10,"maximum":99.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":99.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":89.10,"methodology":"fee schedule"}]}]},{"description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood) UNSCHEDULED","code_information":[{"code":"87102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Culture, fungi, definitive identification, each organism; mold UNSCHEDULED","code_information":[{"code":"87107","type":"CPT"},{"code":"L000341802","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":31.50,"maximum":35.00,"gross_charge":206.50,"discounted_cash":206.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":35.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":33.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":31.50,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed UNSCHEDULED","code_information":[{"code":"87149","type":"CPT"},{"code":"L000343302","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":38.70,"maximum":43.00,"gross_charge":351.25,"discounted_cash":351.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":43.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":38.70,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum UNSCHEDULED","code_information":[{"code":"87147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36.90,"maximum":41.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":41.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":36.90,"methodology":"fee schedule"}]}]},{"description":"Curettage or cautery of anal fissure, including dilation of anal sphincter (separate procedure); subsequent UNSCHEDULED","code_information":[{"code":"46942","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"Cutaneous vesicostomy SCHEDULED","code_information":[{"code":"51980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cutaneous vesicostomy UNSCHEDULED","code_information":[{"code":"51980","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder SCHEDULED","code_information":[{"code":"51596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; SCHEDULED","code_information":[{"code":"51580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes UNSCHEDULED","code_information":[{"code":"51575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy) UNSCHEDULED","code_information":[{"code":"51565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystorrhaphy, suture of bladder wound, injury or rupture; complicated SCHEDULED","code_information":[{"code":"51865","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystorrhaphy, suture of bladder wound, injury or rupture; complicated UNSCHEDULED","code_information":[{"code":"51865","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystostomy, cystotomy with drainage UNSCHEDULED","code_information":[{"code":"51040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystotomy or cystostomy, with fulguration and/or insertion of radioactive material UNSCHEDULED","code_information":[{"code":"51020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystotomy, with insertion of ureteral catheter or stent (separate procedure) SCHEDULED","code_information":[{"code":"51045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus UNSCHEDULED","code_information":[{"code":"52320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy SCHEDULED","code_information":[{"code":"52335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy with irrigation and evacuation of multiple obstructing clots UNSCHEDULED","code_information":[{"code":"52001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3043.80,"maximum":3382.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3382.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3212.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3043.80,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia UNSCHEDULED","code_information":[{"code":"52265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE bladder tumor(s) SCHEDULED","code_information":[{"code":"52240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm) SCHEDULED","code_information":[{"code":"52234","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with injection(s) for chemodenervation of the bladder SCHEDULED","code_information":[{"code":"52287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple UNSCHEDULED","code_information":[{"code":"52310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis SCHEDULED","code_information":[{"code":"52007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion SCHEDULED","code_information":[{"code":"52354","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included) SCHEDULED","code_information":[{"code":"52352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation, laser, electrocautery, and incision) UNSCHEDULED","code_information":[{"code":"52343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery, and incision) SCHEDULED","code_information":[{"code":"52341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision) UNSCHEDULED","code_information":[{"code":"52342","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral UNSCHEDULED","code_information":[{"code":"52290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cytomegalovirus antibody dfa UNSCHEDULED","code_information":[{"code":"87198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":89.10,"maximum":99.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":99.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":89.10,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual UNSCHEDULED","code_information":[{"code":"88120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.70,"maximum":153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":137.70,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening under physician supervision UNSCHEDULED","code_information":[{"code":"88166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.70,"maximum":153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":137.70,"methodology":"fee schedule"}]}]},{"description":"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone UNSCHEDULED","code_information":[{"code":"11012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1849.50,"maximum":2055.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2055.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1952.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1849.50,"methodology":"fee schedule"}]}]},{"description":"Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum UNSCHEDULED","code_information":[{"code":"11004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1099.80,"maximum":1222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1160.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1099.80,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; without debridement of nonviable muscle and/or nerve SCHEDULED","code_information":[{"code":"25020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3083.40,"maximum":3426.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3426.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3254.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3083.40,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve UNSCHEDULED","code_information":[{"code":"27894","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2755.80,"maximum":3062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3062.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2908.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2755.80,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); SCHEDULED","code_information":[{"code":"27496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Decompression; unspecified nerve(s) (specify) UNSCHEDULED","code_information":[{"code":"64722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at trunk SCHEDULED","code_information":[{"code":"15600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3712.50,"maximum":4125.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4125.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3918.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3712.50,"methodology":"fee schedule"}]}]},{"description":"Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device UNSCHEDULED","code_information":[{"code":"94664","type":"CPT"},{"code":"R000005601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"gross_charge":223.25,"discounted_cash":223.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Dermabrasion; regional, other than face SCHEDULED","code_information":[{"code":"15782","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2364.30,"maximum":2627.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2627.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2364.30,"methodology":"fee schedule"}]}]},{"description":"Descending thoracic aorta graft, with or without bypass SCHEDULED","code_information":[{"code":"33875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint UNSCHEDULED","code_information":[{"code":"64633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1375.20,"maximum":1528.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1528.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1451.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1375.20,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for p UNSCHEDULED","code_information":[{"code":"64636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1119.60,"maximum":1244.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1244.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1181.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1119.60,"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 SCHEDULED","code_information":[{"code":"64635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus UNSCHEDULED","code_information":[{"code":"64680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":882.00,"maximum":980.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":980.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":931.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":882.00,"methodology":"fee schedule"}]}]},{"description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm SCHEDULED","code_information":[{"code":"17107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":758.70,"maximum":843.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":843.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":800.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":758.70,"methodology":"fee schedule"}]}]},{"description":"Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure) UNSCHEDULED","code_information":[{"code":"66770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"DESTRUCTION OF HEMORRHOIDS UNSCHEDULED","code_information":[{"code":"46935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical SCHEDULED","code_information":[{"code":"46900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2247.30,"maximum":2497.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2497.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2247.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical UNSCHEDULED","code_information":[{"code":"46900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery UNSCHEDULED","code_information":[{"code":"46917","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision SCHEDULED","code_information":[{"code":"46922","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2247.30,"maximum":2497.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2497.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2247.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion, conjunctiva SCHEDULED","code_information":[{"code":"68135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1697.40,"maximum":1886.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1886.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1791.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1697.40,"methodology":"fee schedule"}]}]},{"description":"Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or more sessions; radiation by implantation of source (includes removal of source) SCHEDULED","code_information":[{"code":"67218","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5356.80,"maximum":5952.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5952.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5654.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5356.80,"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 SCHEDULED","code_information":[{"code":"17280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm SCHEDULED","code_information":[{"code":"17283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"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 SCHEDULED","code_information":[{"code":"17263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm UNSCHEDULED","code_information":[{"code":"17264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations UNSCHEDULED","code_information":[{"code":"78414","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes UNSCHEDULED","code_information":[{"code":"92622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.20,"maximum":218.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":218.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":207.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":196.20,"methodology":"fee schedule"}]}]},{"description":"Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation neces SCHEDULED","code_information":[{"code":"36909","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Dihydrotestosterone (DHT) UNSCHEDULED","code_information":[{"code":"82642","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Dilation of esophagus, by unguided sound or bougie, single or multiple passes SCHEDULED","code_information":[{"code":"43450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Dilation of urethral stricture by passage of filiform and follower, male; initial UNSCHEDULED","code_information":[{"code":"53620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6759.90,"maximum":7511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7135.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6759.90,"methodology":"fee schedule"}]}]},{"description":"Dilation of vagina under anesthesia (other than local) SCHEDULED","code_information":[{"code":"57400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"DILATION PROSTATIC URETHRA UNSCHEDULED","code_information":[{"code":"52510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Diphtheria antitoxin, equine, any route UNSCHEDULED","code_information":[{"code":"90296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":920.70,"maximum":1023.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1023.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":971.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":920.70,"methodology":"fee schedule"}]}]},{"description":"Direct nasal mucous membrane test UNSCHEDULED","code_information":[{"code":"95065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":83.70,"maximum":93.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":93.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":83.70,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, axillary-brachial artery, by SCHEDULED","code_information":[{"code":"35011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta involving visceral vessels (mesenteri SCHEDULED","code_information":[{"code":"35092","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, hepatic, celiac, renal, or mesenteric artery SCHEDULED","code_information":[{"code":"35122","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, iliac artery (common, hypogastric, external) SCHEDULED","code_information":[{"code":"35132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, innominate, subclavian artery, by thoracic incision SCHEDULED","code_information":[{"code":"35022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Disarticulation at knee UNSCHEDULED","code_information":[{"code":"27598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Disarticulation of shoulder; secondary closure or scar revision UNSCHEDULED","code_information":[{"code":"23921","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"Disarticulation through wrist; SCHEDULED","code_information":[{"code":"25920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace SCHEDULED","code_information":[{"code":"63075","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3437.10,"maximum":3819.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3819.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3628.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3437.10,"methodology":"fee schedule"}]}]},{"description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, each additional interspace (List separately in addition to code for primary procedure SCHEDULED","code_information":[{"code":"63078","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, single interspace SCHEDULED","code_information":[{"code":"63077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Displacement therapy (Proetz type) UNSCHEDULED","code_information":[{"code":"30210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":479.70,"maximum":533.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":533.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":506.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":479.70,"methodology":"fee schedule"}]}]},{"description":"Dissection, deep jugular node(s) SCHEDULED","code_information":[{"code":"38542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5097.60,"maximum":5664.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5664.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5380.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5097.60,"methodology":"fee schedule"}]}]},{"description":"Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach SCHEDULED","code_information":[{"code":"43130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAK SCHEDULED","code_information":[{"code":"99328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":221.40,"maximum":246.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":246.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":233.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":221.40,"methodology":"fee schedule"}]}]},{"description":"DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION MAKING OF MOD SCHEDULED","code_information":[{"code":"99326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138.60,"maximum":154.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":154.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":146.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":138.60,"methodology":"fee schedule"}]}]},{"description":"DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED INTERVAL HISTORY; AN EXPAND SCHEDULED","code_information":[{"code":"99335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95.40,"maximum":106.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":106.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":100.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":95.40,"methodology":"fee schedule"}]}]},{"description":"Donor hepatectomy (including cold preservation), from living donor; left lateral segment only (segments II and III) SCHEDULED","code_information":[{"code":"47140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418.40,"maximum":1576.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1576.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1497.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1418.40,"methodology":"fee schedule"}]}]},{"description":"Donor pneumonectomy(s) (including cold preservation), from cadaver donor SCHEDULED","code_information":[{"code":"32850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2166.30,"maximum":2407.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2286.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2166.30,"methodology":"fee schedule"}]}]},{"description":"Donor pneumonectomy(s) (including cold preservation), from cadaver donor UNSCHEDULED","code_information":[{"code":"32850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1427.40,"maximum":1586.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1586.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1506.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1427.40,"methodology":"fee schedule"}]}]},{"description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete SCHEDULED","code_information":[{"code":"93320","type":"CPT"},{"code":"C000023201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":58.50,"maximum":65.00,"gross_charge":2756.75,"discounted_cash":2756.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":65.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":61.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":58.50,"methodology":"fee schedule"}]}]},{"description":"Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited study (List separately in UNSCHEDULED","code_information":[{"code":"93321","type":"CPT"},{"code":"C000023301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":366.30,"maximum":407.00,"gross_charge":1734.25,"discounted_cash":1734.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":386.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":366.30,"methodology":"fee schedule"}]}]},{"description":"Drainage external ear, abscess or hematoma; simple UNSCHEDULED","code_information":[{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3308.40,"maximum":3676.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3676.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3492.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3308.40,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess; parotid, complicated SCHEDULED","code_information":[{"code":"42305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess; parotid, complicated UNSCHEDULED","code_information":[{"code":"42305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3762.90,"maximum":4181.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4181.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3971.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3762.90,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess; submaxillary or sublingual, intraoral UNSCHEDULED","code_information":[{"code":"42310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3762.90,"maximum":4181.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4181.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3971.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3762.90,"methodology":"fee schedule"}]}]},{"description":"Drainage of palmar bursa; multiple bursa SCHEDULED","code_information":[{"code":"26030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4054.50,"maximum":4505.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4505.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4054.50,"methodology":"fee schedule"}]}]},{"description":"Drainage of palmar bursa; single, bursa SCHEDULED","code_information":[{"code":"26025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4054.50,"maximum":4505.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4505.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4054.50,"methodology":"fee schedule"}]}]},{"description":"Drainage of subdiaphragmatic or subphrenic abscess, open SCHEDULED","code_information":[{"code":"49040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"Drainage of subdiaphragmatic or subphrenic abscess, open UNSCHEDULED","code_information":[{"code":"49040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4673.70,"maximum":5193.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5193.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4933.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4673.70,"methodology":"fee schedule"}]}]},{"description":"Drainage of tendon sheath, digit and/or palm, each UNSCHEDULED","code_information":[{"code":"26020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3672.00,"maximum":4080.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4080.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3876.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3672.00,"methodology":"fee schedule"}]}]},{"description":"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment UNSCHEDULED","code_information":[{"code":"77085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187.20,"maximum":208.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":208.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":197.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":187.20,"methodology":"fee schedule"}]}]},{"description":"Duodenal intubation and aspiration, diagnostic, includes image guidance; collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube, includes d UNSCHEDULED","code_information":[{"code":"43757","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1164.60,"maximum":1294.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1294.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1229.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1164.60,"methodology":"fee schedule"}]}]},{"description":"Duodenotomy, for exploration, biopsy(s), or foreign body removal SCHEDULED","code_information":[{"code":"44010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete bilateral study UNSCHEDULED","code_information":[{"code":"93985","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":617.40,"maximum":686.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":686.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":651.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":617.40,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete unilateral study UNSCHEDULED","code_information":[{"code":"93986","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":617.40,"maximum":686.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":686.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":651.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":617.40,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study SCHEDULED","code_information":[{"code":"93926","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105.30,"maximum":117.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":117.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":111.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":105.30,"methodology":"fee schedule"}]}]},{"description":"Dural graft, spinal UNSCHEDULED","code_information":[{"code":"63710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"DXA BONE DENSITY VERT FX UNSCHEDULED","code_information":[{"code":"77082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":187.20,"maximum":208.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":208.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":197.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":187.20,"methodology":"fee schedule"}]}]},{"description":"ECG MONITOR/REPORT, 24 HRS UNSCHEDULED","code_information":[{"code":"93232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463.50,"maximum":515.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":515.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":489.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":463.50,"methodology":"fee schedule"}]}]},{"description":"ECG MONITOR/REPORT, 24 HRS UNSCHEDULED","code_information":[{"code":"93235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463.50,"maximum":515.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":515.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":489.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":463.50,"methodology":"fee schedule"}]}]},{"description":"ECHO GUIDANCE RADIOTHERAPY UNSCHEDULED","code_information":[{"code":"76950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":763.20,"maximum":848.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":848.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":763.20,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg, TAVR, transcatheter pulmonary valve replacement, mitral valve re UNSCHEDULED","code_information":[{"code":"93355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1452.60,"maximum":1614.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1614.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1533.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1452.60,"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 ( UNSCHEDULED","code_information":[{"code":"93318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2378.70,"maximum":2643.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2643.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2510.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2378.70,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only SCHEDULED","code_information":[{"code":"93313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68.40,"maximum":76.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":76.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":72.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":68.40,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echoc UNSCHEDULED","code_information":[{"code":"93306","type":"CPT"},{"code":"C000022101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":1593.00,"maximum":1770.00,"gross_charge":3480.50,"discounted_cash":3480.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1770.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1681.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1593.00,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or SCHEDULED","code_information":[{"code":"93350","type":"CPT"},{"code":"C000023501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":113.40,"maximum":126.00,"gross_charge":5162.00,"discounted_cash":5162.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":126.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":119.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":113.40,"methodology":"fee schedule"}]}]},{"description":"Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnor UNSCHEDULED","code_information":[{"code":"76506","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":632.70,"maximum":703.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":703.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":667.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":632.70,"methodology":"fee schedule"}]}]},{"description":"Electrical stimulation, (unattended), to one or more areas, for wound care other than described in g0281 UNSCHEDULED","code_information":[{"code":"G0282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":270.90,"maximum":301.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":301.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":285.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":270.90,"methodology":"fee schedule"}]}]},{"description":"Electroacoustic evaluation for hearing aid; binaural UNSCHEDULED","code_information":[{"code":"92595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":323.10,"maximum":359.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":359.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":341.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":323.10,"methodology":"fee schedule"}]}]},{"description":"Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination SCHEDULED","code_information":[{"code":"G0404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8.10,"maximum":9.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8.10,"methodology":"fee schedule"}]}]},{"description":"Electrocochleography UNSCHEDULED","code_information":[{"code":"92584","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":316.80,"maximum":352.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":352.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":334.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":316.80,"methodology":"fee schedule"}]}]},{"description":"Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use UNSCHEDULED","code_information":[{"code":"90682","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base, nasopharynx), with or without disarticulation of the mandible, including parot UNSCHEDULED","code_information":[{"code":"61590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consult SCHEDULED","code_information":[{"code":"99494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43.20,"maximum":48.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":48.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":45.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":43.20,"methodology":"fee schedule"}]}]},{"description":"INITIAL VENTILATOR MGMT UNSCHEDULED","code_information":[{"code":"94656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"INJ PARAVERTEBRAL C/T SCHEDULED","code_information":[{"code":"64470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Inject anes 1 paravert N SCHEDULED","code_information":[{"code":"64440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"INJECTION FOR KIDNEY X-RAY UNSCHEDULED","code_information":[{"code":"50394","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"INJECTION OF CONTRAST FOR KNEE ARTHROGRAPHY UNSCHEDULED","code_information":[{"code":"27370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Injection of sclerosing solution, hemorrhoids UNSCHEDULED","code_information":[{"code":"46500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aorto SCHEDULED","code_information":[{"code":"93564","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66.60,"maximum":74.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":74.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":70.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":66.60,"methodology":"fee schedule"}]}]},{"description":"Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to co UNSCHEDULED","code_information":[{"code":"93573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10276.20,"maximum":11418.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11418.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10847.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":10276.20,"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 UNSCHEDULED","code_information":[{"code":"47532","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1163.70,"maximum":1293.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1293.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1228.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1163.70,"methodology":"fee schedule"}]}]},{"description":"Injection procedure for discography, each level; lumbar SCHEDULED","code_information":[{"code":"62290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Injection procedure for elbow arthrography SCHEDULED","code_information":[{"code":"24220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6528.60,"maximum":7254.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7254.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6891.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6528.60,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging guidance, when performed SCHEDULED","code_information":[{"code":"64417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement), including imaging guidance, when performed UNSCHEDULED","code_information":[{"code":"64416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2798.10,"maximum":3109.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3109.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2953.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2798.10,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, including imaging guidance, when performed SCHEDULED","code_information":[{"code":"64447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve UNSCHEDULED","code_information":[{"code":"64405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":738.00,"maximum":820.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":820.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":779.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":738.00,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, Morton's neuroma) SCHEDULED","code_information":[{"code":"64455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"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 SCHEDULED","code_information":[{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular) UNSCHEDULED","code_information":[{"code":"64400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":405.00,"maximum":450.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":450.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":427.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":405.00,"methodology":"fee schedule"}]}]},{"description":"Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level SCHEDULED","code_information":[{"code":"64490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) UNSCHEDULED","code_information":[{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":560.70,"maximum":623.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":623.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":591.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":560.70,"methodology":"fee schedule"}]}]},{"description":"Injection(s); single or multiple trigger point(s), 3 or more muscles UNSCHEDULED","code_information":[{"code":"20553","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":766.80,"maximum":852.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":852.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":809.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":766.80,"methodology":"fee schedule"}]}]},{"description":"INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE) SCHEDULED","code_information":[{"code":"64508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE) UNSCHEDULED","code_information":[{"code":"64508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"INJECTION, ANESTHETIC AGENT; FACIAL NERVE UNSCHEDULED","code_information":[{"code":"64402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) UNSCHEDULED","code_information":[{"code":"64520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1698.30,"maximum":1887.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1887.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1792.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1698.30,"methodology":"fee schedule"}]}]},{"description":"Injection, anesthetic agent; superior hypogastric plexus UNSCHEDULED","code_information":[{"code":"64517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"INJECTION, CARDIAC CATH UNSCHEDULED","code_information":[{"code":"93539","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10276.20,"maximum":11418.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11418.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10847.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":10276.20,"methodology":"fee schedule"}]}]},{"description":"Injection, intralesional; up to and including 7 lesions UNSCHEDULED","code_information":[{"code":"11900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":560.70,"maximum":623.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":623.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":591.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":560.70,"methodology":"fee schedule"}]}]},{"description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal) SCHEDULED","code_information":[{"code":"62282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid SCHEDULED","code_information":[{"code":"62280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"INSERT INTRACORONARY STENT UNSCHEDULED","code_information":[{"code":"92981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7257.60,"maximum":8064.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8064.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7660.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7257.60,"methodology":"fee schedule"}]}]},{"description":"Insert urinary catheter UNSCHEDULED","code_information":[{"code":"53670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6759.90,"maximum":7511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7135.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6759.90,"methodology":"fee schedule"}]}]},{"description":"Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator UNSCHEDULED","code_information":[{"code":"33217","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator SCHEDULED","code_information":[{"code":"33216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5475.60,"maximum":6084.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6084.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5779.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5475.60,"methodology":"fee schedule"}]}]},{"description":"Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator UNSCHEDULED","code_information":[{"code":"33216","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of a temporary prostatic urethral stent, including urethral measurement UNSCHEDULED","code_information":[{"code":"53855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6759.90,"maximum":7511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7135.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6759.90,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF ACCESS DEVICE SCHEDULED","code_information":[{"code":"36533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach SCHEDULED","code_information":[{"code":"66183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3851.10,"maximum":4279.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4065.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3851.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of arterial and venous cannula(s) for isolated extracorporeal circulation including regional chemotherapy perfusion to an extremity, with or without hyperthermia, with removal of cannula(s) SCHEDULED","code_information":[{"code":"36823","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF CATHETER, VEIN SCHEDULED","code_information":[{"code":"36488","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy) SCHEDULED","code_information":[{"code":"33203","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of graft, aorta or great vessels; with cardiopulmonary bypass UNSCHEDULED","code_information":[{"code":"33335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of implantable defibrillator pulse generator only; with existing multiple leads UNSCHEDULED","code_information":[{"code":"33231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of implantable defibrillator pulse generator only; with existing single lead UNSCHEDULED","code_information":[{"code":"33240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF INFUSION PUMP UNSCHEDULED","code_information":[{"code":"36530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc spac SCHEDULED","code_information":[{"code":"22853","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3571.20,"maximum":3968.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3968.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3769.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3571.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level SCHEDULED","code_information":[{"code":"22867","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14730.30,"maximum":16367.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":16367.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15548.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14730.30,"methodology":"fee schedule"}]}]},{"description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level UNSCHEDULED","code_information":[{"code":"22867","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous UNSCHEDULED","code_information":[{"code":"22859","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) SCHEDULED","code_information":[{"code":"51701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of pacemaker pulse generator only; with existing single lead UNSCHEDULED","code_information":[{"code":"33212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, without imaging guidance; younger than 5 years of age SCHEDULED","code_information":[{"code":"36568","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of pin-retained palatal prosthesis UNSCHEDULED","code_information":[{"code":"42281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":445.50,"maximum":495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":470.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":445.50,"methodology":"fee schedule"}]}]},{"description":"Insertion of testicular prosthesis (separate procedure) SCHEDULED","code_information":[{"code":"54660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5758.20,"maximum":6398.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6398.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6078.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5758.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of Thomas shunt (separate procedure) UNSCHEDULED","code_information":[{"code":"36835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"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) SCHEDULED","code_information":[{"code":"36565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy SCHEDULED","code_information":[{"code":"57155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Insertion of ventricular assist device; extracorporeal, biventricular UNSCHEDULED","code_information":[{"code":"33976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver SCHEDULED","code_information":[{"code":"64590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3610.80,"maximum":4012.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4012.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3811.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3610.80,"methodology":"fee schedule"}]}]},{"description":"INSTILL AIRWAY CONTRAST DYE UNSCHEDULED","code_information":[{"code":"31708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2259.90,"maximum":2511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2385.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2259.90,"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) SCHEDULED","code_information":[{"code":"50391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); initial day SCHEDULED","code_information":[{"code":"32561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2166.30,"maximum":2407.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2286.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2166.30,"methodology":"fee schedule"}]}]},{"description":"Insulin tolerance panel; for ACTH insufficiency This panel must include the following: Cortisol (82533 x 5) Glucose (82947 x 5) UNSCHEDULED","code_information":[{"code":"80434","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118.80,"maximum":132.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":132.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":125.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":118.80,"methodology":"fee schedule"}]}]},{"description":"Insulin; free UNSCHEDULED","code_information":[{"code":"83527","type":"CPT"},{"code":"L000162401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"gross_charge":354.50,"discounted_cash":354.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"INTAC PSY DX INTERVIEW UNSCHEDULED","code_information":[{"code":"90802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199.80,"maximum":222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":210.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":199.80,"methodology":"fee schedule"}]}]},{"description":"Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications UNSCHEDULED","code_information":[{"code":"77301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3284.10,"maximum":3649.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3649.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3466.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3284.10,"methodology":"fee schedule"}]}]},{"description":"Interactive complexity (List separately in addition to the code for primary procedure) SCHEDULED","code_information":[{"code":"90785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.40,"maximum":16.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14.40,"methodology":"fee schedule"}]}]},{"description":"Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis) SCHEDULED","code_information":[{"code":"64727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2771.10,"maximum":3079.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3079.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2925.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2771.10,"methodology":"fee schedule"}]}]},{"description":"Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other quali SCHEDULED","code_information":[{"code":"93295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38.70,"maximum":43.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":43.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":38.70,"methodology":"fee schedule"}]}]},{"description":"Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements fro SCHEDULED","code_information":[{"code":"93297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.90,"maximum":31.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":31.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":27.90,"methodology":"fee schedule"}]}]},{"description":"Interrogation device evaluation(s), (remote) up to 30 days; subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physici UNSCHEDULED","code_information":[{"code":"93298","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.20,"maximum":218.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":218.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":207.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":196.20,"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 UNSCHEDULED","code_information":[{"code":"93750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement UNSCHEDULED","code_information":[{"code":"93650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14165.10,"maximum":15739.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":15739.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":14952.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14165.10,"methodology":"fee schedule"}]}]},{"description":"Intraoperative colonic lavage (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"44701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primar UNSCHEDULED","code_information":[{"code":"96547","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":635.40,"maximum":706.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":706.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":670.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":635.40,"methodology":"fee schedule"}]}]},{"description":"Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube SCHEDULED","code_information":[{"code":"94610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":57.60,"maximum":64.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":64.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":60.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":57.60,"methodology":"fee schedule"}]}]},{"description":"Intrapulmonary surfactant administration by a physician or other qualified health care professional through endotracheal tube UNSCHEDULED","code_information":[{"code":"94610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additio SCHEDULED","code_information":[{"code":"93572","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"96361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.50,"maximum":15.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":13.50,"methodology":"fee schedule"}]}]},{"description":"Intravenous infusion, hydration; initial, 31 minutes to 1 hour UNSCHEDULED","code_information":[{"code":"96360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224.10,"maximum":249.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":249.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":236.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":224.10,"methodology":"fee schedule"}]}]},{"description":"Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure) UNSCHEDULED","code_information":[{"code":"44500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"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 SCHEDULED","code_information":[{"code":"36903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Iridectomy, with corneoscleral or corneal section; optical (separate procedure) UNSCHEDULED","code_information":[{"code":"66635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Iridectomy, with corneoscleral or corneal section; sector for glaucoma (separate procedure) UNSCHEDULED","code_information":[{"code":"66630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Iron stain, peripheral blood UNSCHEDULED","code_information":[{"code":"85536","type":"CPT"},{"code":"L000208801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":87.30,"maximum":97.00,"gross_charge":183.00,"discounted_cash":183.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":97.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":92.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":87.30,"methodology":"fee schedule"}]}]},{"description":"Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) UNSCHEDULED","code_information":[{"code":"95875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":285.30,"maximum":317.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":317.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":301.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":285.30,"methodology":"fee schedule"}]}]},{"description":"Islet cell antibody UNSCHEDULED","code_information":[{"code":"86341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46.80,"maximum":52.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":52.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":49.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":46.80,"methodology":"fee schedule"}]}]},{"description":"Isocitric dehydrogenase (IDH) UNSCHEDULED","code_information":[{"code":"83570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"JOINT SURVEY, SINGLE VIEW UNSCHEDULED","code_information":[{"code":"76066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.90,"maximum":561.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":561.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":532.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":504.90,"methodology":"fee schedule"}]}]},{"description":"Keratoplasty (corneal transplant); endothelial UNSCHEDULED","code_information":[{"code":"65756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"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) UNSCHEDULED","code_information":[{"code":"78709","type":"CPT"},{"code":"I000171401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"gross_charge":6973.25,"discounted_cash":6973.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"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 UNSCHEDULED","code_information":[{"code":"81272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Krukenberg procedure SCHEDULED","code_information":[{"code":"25915","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Lactate dehydrogenase (LD), (LDH); UNSCHEDULED","code_information":[{"code":"83615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"LAMINECTOMY AND SECTION OF DENTATE LIGAMENTS, WITH OR WITHOUT DURAL GRAFT, CERVICAL; 1 OR 2 SEGMENTS UNSCHEDULED","code_information":[{"code":"63180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral UNSCHEDULED","code_information":[{"code":"63278","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical SCHEDULED","code_information":[{"code":"63280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic SCHEDULED","code_information":[{"code":"63281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; lumbar UNSCHEDULED","code_information":[{"code":"63272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; sacral UNSCHEDULED","code_information":[{"code":"63268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; thoracic UNSCHEDULED","code_information":[{"code":"63251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural SCHEDULED","code_information":[{"code":"63655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8892.00,"maximum":9880.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9880.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9386.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8892.00,"methodology":"fee schedule"}]}]},{"description":"Laminectomy with drainage of intramedullary cyst/syrinx; to subarachnoid space SCHEDULED","code_information":[{"code":"63172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"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), 1 or 2 vertebral segments; cervical UNSCHEDULED","code_information":[{"code":"63001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"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; lumbar UNSCHEDULED","code_information":[{"code":"63017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) UNSCHEDULED","code_information":[{"code":"63012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy with section of spinal accessory nerve SCHEDULED","code_information":[{"code":"63191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve rootºs», ºeg, spinal or lateral recess stenosis»), single vertebral segm UNSCHEDULED","code_information":[{"code":"63047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6805.80,"maximum":7562.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7562.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7183.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6805.80,"methodology":"fee schedule"}]}]},{"description":"Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve rootºs» ºeg, spinal or lateral recess stenosis»), during posterior inter SCHEDULED","code_information":[{"code":"63053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve rootºs» ºeg, spinal or lateral recess stenosis»), during posterior inter UNSCHEDULED","code_information":[{"code":"63053","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, ablation of 1 or more liver tumor(s); cryosurgical SCHEDULED","code_information":[{"code":"47371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418.40,"maximum":1576.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1576.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1497.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1418.40,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when performed UNSCHEDULED","code_information":[{"code":"43279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh UNSCHEDULED","code_information":[{"code":"43282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; cholecystectomy with cholangiography UNSCHEDULED","code_information":[{"code":"47563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1163.70,"maximum":1293.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1293.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1228.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1163.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy UNSCHEDULED","code_information":[{"code":"44205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum SCHEDULED","code_information":[{"code":"43647","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6477.30,"maximum":7197.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7197.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6837.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6477.30,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding) SCHEDULED","code_information":[{"code":"44186","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; proctopexy (for prolapse) UNSCHEDULED","code_information":[{"code":"45400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection UNSCHEDULED","code_information":[{"code":"45402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; repair recurrent inguinal hernia UNSCHEDULED","code_information":[{"code":"49651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4673.70,"maximum":5193.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5193.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4933.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4673.70,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; transection of vagus nerves, selective or highly selective SCHEDULED","code_information":[{"code":"43652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6477.30,"maximum":7197.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7197.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6837.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6477.30,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple) SCHEDULED","code_information":[{"code":"49322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with biopsy (single or multiple) SCHEDULED","code_information":[{"code":"49321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with omentopexy (omental tacking procedure) (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"49326","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"Laryngectomy; subtotal supraglottic, with radical neck dissection SCHEDULED","code_information":[{"code":"31368","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngectomy; total, with radical neck dissection SCHEDULED","code_information":[{"code":"31365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with foreign body removal; SCHEDULED","code_information":[{"code":"31530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with foreign body removal; UNSCHEDULED","code_information":[{"code":"31530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) SCHEDULED","code_information":[{"code":"31545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) UNSCHEDULED","code_information":[{"code":"31545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, flexible; with biopsy(ies) SCHEDULED","code_information":[{"code":"31576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, indirect; with removal of lesion SCHEDULED","code_information":[{"code":"31512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3339.90,"maximum":3711.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3711.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3525.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3339.90,"methodology":"fee schedule"}]}]},{"description":"Lateral canthopexy UNSCHEDULED","code_information":[{"code":"21282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"methodology":"fee schedule"}]}]},{"description":"Lengthening of palate, and pharyngeal flap SCHEDULED","code_information":[{"code":"42226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2242.80,"maximum":2492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2367.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2242.80,"methodology":"fee schedule"}]}]},{"description":"Lengthening of palate, with island flap UNSCHEDULED","code_information":[{"code":"42227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":445.50,"maximum":495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":470.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":445.50,"methodology":"fee schedule"}]}]},{"description":"Lengthening of tendon, flexor, hand or finger, each tendon UNSCHEDULED","code_information":[{"code":"26478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon SCHEDULED","code_information":[{"code":"25280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4515.30,"maximum":5017.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5017.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4766.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4515.30,"methodology":"fee schedule"}]}]},{"description":"Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon UNSCHEDULED","code_information":[{"code":"25280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3509.10,"maximum":3899.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3899.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3704.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3509.10,"methodology":"fee schedule"}]}]},{"description":"LESION REMOVAL COLONOSCOPY SCHEDULED","code_information":[{"code":"45383","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Leukocyte histamine release test (LHR) UNSCHEDULED","code_information":[{"code":"86343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Ligamentous reconstruction (augmentation), knee; intra-articular (open) SCHEDULED","code_information":[{"code":"27428","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16245.00,"maximum":18050.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":18050.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":17147.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":16245.00,"methodology":"fee schedule"}]}]},{"description":"Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions UNSCHEDULED","code_information":[{"code":"37700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"33924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Ligation of femoral vein SCHEDULED","code_information":[{"code":"37650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg SCHEDULED","code_information":[{"code":"37760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Ligation, major artery (eg, post-traumatic, rupture); chest UNSCHEDULED","code_information":[{"code":"37616","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Ligation; external carotid artery SCHEDULED","code_information":[{"code":"37600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic SCHEDULED","code_information":[{"code":"38562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5097.60,"maximum":5664.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5664.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5380.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5097.60,"methodology":"fee schedule"}]}]},{"description":"Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) UNSCHEDULED","code_information":[{"code":"80061","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":190.80,"maximum":212.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":212.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":201.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":190.80,"methodology":"fee schedule"}]}]},{"description":"Lithotripsy, extracorporeal shock wave SCHEDULED","code_information":[{"code":"50590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report UNSCHEDULED","code_information":[{"code":"91200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":230.40,"maximum":256.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":256.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":243.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":230.40,"methodology":"fee schedule"}]}]},{"description":"LONG QT SYND GENE FULL SEQ UNSCHEDULED","code_information":[{"code":"81280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy ºPOEM») UNSCHEDULED","code_information":[{"code":"43497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Lumbar/caudal inject NEC UNSCHEDULED","code_information":[{"code":"62289","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1937.70,"maximum":2153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2045.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1937.70,"methodology":"fee schedule"}]}]},{"description":"Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation UNSCHEDULED","code_information":[{"code":"75805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1989.00,"maximum":2210.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2210.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2099.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1989.00,"methodology":"fee schedule"}]}]},{"description":"Lymphatics and lymph nodes imaging UNSCHEDULED","code_information":[{"code":"78195","type":"CPT"},{"code":"I000162701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"gross_charge":6643.75,"discounted_cash":6643.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Macroscopic examination; arthropod UNSCHEDULED","code_information":[{"code":"87168","type":"CPT"},{"code":"L000347401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":42.30,"maximum":47.00,"gross_charge":121.25,"discounted_cash":121.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":47.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":42.30,"methodology":"fee schedule"}]}]},{"description":"Macroscopic examination; parasite UNSCHEDULED","code_information":[{"code":"87169","type":"CPT"},{"code":"L000347501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":89.10,"maximum":99.00,"gross_charge":130.00,"discounted_cash":130.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":99.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":94.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":89.10,"methodology":"fee schedule"}]}]},{"description":"Magnesium UNSCHEDULED","code_information":[{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":85.50,"maximum":95.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":95.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":90.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":85.50,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) UNSCHEDULED","code_information":[{"code":"73222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2786.40,"maximum":3096.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3096.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2941.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2786.40,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) UNSCHEDULED","code_information":[{"code":"73719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4421.70,"maximum":4913.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4667.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4421.70,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) UNSCHEDULED","code_information":[{"code":"72195","type":"CPT"},{"code":"I000080701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2443.50,"maximum":2715.00,"gross_charge":6965.50,"discounted_cash":6965.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2715.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2579.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2443.50,"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 UNSCHEDULED","code_information":[{"code":"72158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3074.40,"maximum":3416.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3416.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3245.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3074.40,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) UNSCHEDULED","code_information":[{"code":"73219","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1545.30,"maximum":1717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1631.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1545.30,"methodology":"fee schedule"}]}]},{"description":"Management of liver hemorrhage; re-exploration of hepatic wound for removal of packing SCHEDULED","code_information":[{"code":"47362","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418.40,"maximum":1576.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1576.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1497.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1418.40,"methodology":"fee schedule"}]}]},{"description":"Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) SCHEDULED","code_information":[{"code":"27860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5598.00,"maximum":6220.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6220.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5909.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5598.00,"methodology":"fee schedule"}]}]},{"description":"Manipulation, finger joint, under anesthesia, each joint UNSCHEDULED","code_information":[{"code":"26340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); SCHEDULED","code_information":[{"code":"19301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3659.40,"maximum":4066.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4066.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3862.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3659.40,"methodology":"fee schedule"}]}]},{"description":"Mastoidectomy; complete SCHEDULED","code_information":[{"code":"69502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8725.50,"maximum":9695.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9695.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9210.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8725.50,"methodology":"fee schedule"}]}]},{"description":"Maxillary impression for palatal prosthesis SCHEDULED","code_information":[{"code":"42280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2242.80,"maximum":2492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2367.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2242.80,"methodology":"fee schedule"}]}]},{"description":"Maxillectomy; without orbital exenteration UNSCHEDULED","code_information":[{"code":"31225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Meat fibers, feces UNSCHEDULED","code_information":[{"code":"89160","type":"CPT"},{"code":"L000427201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":81.00,"maximum":90.00,"gross_charge":103.25,"discounted_cash":103.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":90.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":85.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":81.00,"methodology":"fee schedule"}]}]},{"description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation UNSCHEDULED","code_information":[{"code":"75902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1989.00,"maximum":2210.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2210.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2099.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1989.00,"methodology":"fee schedule"}]}]},{"description":"Medial canthopexy (separate procedure) SCHEDULED","code_information":[{"code":"21280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes UNSCHEDULED","code_information":[{"code":"97804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35.10,"maximum":39.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":39.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":35.10,"methodology":"fee schedule"}]}]},{"description":"Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes SCHEDULED","code_information":[{"code":"97803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28.80,"maximum":32.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":32.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":28.80,"methodology":"fee schedule"}]}]},{"description":"MEDICATION MANAGEMENT UNSCHEDULED","code_information":[{"code":"90862","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199.80,"maximum":222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":210.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":199.80,"methodology":"fee schedule"}]}]},{"description":"Metatarsectomy UNSCHEDULED","code_information":[{"code":"28140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Microsomal antibodies (eg, thyroid or liver-kidney), each UNSCHEDULED","code_information":[{"code":"86376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":102.60,"maximum":114.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":114.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":108.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":102.60,"methodology":"fee schedule"}]}]},{"description":"Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presenc SCHEDULED","code_information":[{"code":"99152","type":"CPT"},{"code":"O000005201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.60,"maximum":14.00,"gross_charge":3902.50,"discounted_cash":3902.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":12.60,"methodology":"fee schedule"}]}]},{"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 SCHEDULED","code_information":[{"code":"17314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"MOLECULE NUCLEIC AMPLI EACH UNSCHEDULED","code_information":[{"code":"83898","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen UNSCHEDULED","code_information":[{"code":"86356","type":"CPT"},{"code":"L000268101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":49.50,"maximum":55.00,"gross_charge":91.75,"discounted_cash":91.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":55.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":52.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":49.50,"methodology":"fee schedule"}]}]},{"description":"Motion fluoroscopic evaluation of swallowing function by cine or video recording SCHEDULED","code_information":[{"code":"92611","type":"CPT"},{"code":"T000040201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":92.70,"maximum":103.00,"gross_charge":2081.50,"discounted_cash":2081.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":103.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":97.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":92.70,"methodology":"fee schedule"}]}]},{"description":"MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants UNSCHEDULED","code_information":[{"code":"81297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius OR ulna SCHEDULED","code_information":[{"code":"25370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo) SCHEDULED","code_information":[{"code":"65600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3851.10,"maximum":4279.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4065.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3851.10,"methodology":"fee schedule"}]}]},{"description":"Muscle transfer, any type, shoulder or upper arm; single UNSCHEDULED","code_information":[{"code":"23395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"Myelography via lumbar injection, including radiological supervision and interpretation; thoracic SCHEDULED","code_information":[{"code":"62303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) UNSCHEDULED","code_information":[{"code":"31231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, diagnostic; with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium) UNSCHEDULED","code_information":[{"code":"31235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa SCHEDULED","code_information":[{"code":"31295","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4244.40,"maximum":4716.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4716.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4480.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4244.40,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region UNSCHEDULED","code_information":[{"code":"31290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy SCHEDULED","code_information":[{"code":"31239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3699.00,"maximum":4110.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4110.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3904.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3699.00,"methodology":"fee schedule"}]}]},{"description":"Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report) SCHEDULED","code_information":[{"code":"43752","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6477.30,"maximum":7197.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7197.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6837.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6477.30,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"95874","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":56.70,"maximum":63.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":63.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":56.70,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary pro SCHEDULED","code_information":[{"code":"95887","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45.00,"maximum":50.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":50.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":47.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":45.00,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography; cranial nerve supplied muscle(s), unilateral SCHEDULED","code_information":[{"code":"95867","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62.10,"maximum":69.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":69.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":65.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":62.10,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography; cranial nerve supplied muscles, bilateral SCHEDULED","code_information":[{"code":"95868","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":74.70,"maximum":83.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":83.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":74.70,"methodology":"fee schedule"}]}]},{"description":"Needle insertion(s) without injection(s); 3 or more muscles SCHEDULED","code_information":[{"code":"20561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Nephrolithotomy; complicated by congenital kidney abnormality SCHEDULED","code_information":[{"code":"50070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Nephrorrhaphy, suture of kidney wound or injury SCHEDULED","code_information":[{"code":"50500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Nerve conduction studies; 3-4 studies SCHEDULED","code_information":[{"code":"95908","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51.30,"maximum":57.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":57.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":51.30,"methodology":"fee schedule"}]}]},{"description":"Nerve conduction studies; 7-8 studies SCHEDULED","code_information":[{"code":"95910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":79.20,"maximum":88.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":88.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":83.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":79.20,"methodology":"fee schedule"}]}]},{"description":"Nerve teasing preparations UNSCHEDULED","code_information":[{"code":"88362","type":"CPT"},{"code":"L000424202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":244.80,"maximum":272.00,"gross_charge":803.75,"discounted_cash":803.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":272.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":258.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":244.80,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty and/or transposition; ulnar nerve at elbow UNSCHEDULED","code_information":[{"code":"64718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1807.20,"maximum":2008.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2008.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1907.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1807.20,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; other than specified UNSCHEDULED","code_information":[{"code":"64708","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY SCALES AND WISCONSIN CARD SORTING TEST), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT, UNSCHEDULED","code_information":[{"code":"96119","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.60,"maximum":14.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":14.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":12.60,"methodology":"fee schedule"}]}]},{"description":"Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise) SCHEDULED","code_information":[{"code":"94761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.00,"maximum":20.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":18.00,"methodology":"fee schedule"}]}]},{"description":"Noonan spectrum disorders (eg, Noonan syndrome, cardio-facio-cutaneous syndrome, Costello syndrome, LEOPARD syndrome, Noonan-like syndrome), genomic sequence analysis panel, must include sequencing of UNSCHEDULED","code_information":[{"code":"81442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"NTRK1 (neurotrophic receptor tyrosine kinase 1) (eg, solid tumors) translocation analysis UNSCHEDULED","code_information":[{"code":"81191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision mak UNSCHEDULED","code_information":[{"code":"99212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126.90,"maximum":141.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":141.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":133.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":126.90,"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 UNSCHEDULED","code_information":[{"code":"81500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":58.50,"maximum":65.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":65.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":61.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":58.50,"methodology":"fee schedule"}]}]},{"description":"Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes UNSCHEDULED","code_information":[{"code":"99422","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35.10,"maximum":39.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":39.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":35.10,"methodology":"fee schedule"}]}]},{"description":"Open subclavian to carotid artery transposition performed in conjunction with endovascular repair of descending thoracic aorta, by neck incision, unilateral UNSCHEDULED","code_information":[{"code":"33889","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment SCHEDULED","code_information":[{"code":"22328","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5043.60,"maximum":5604.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5604.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5323.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5043.60,"methodology":"fee schedule"}]}]},{"description":"Open treatment of acute or chronic elbow dislocation UNSCHEDULED","code_information":[{"code":"24615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each UNSCHEDULED","code_information":[{"code":"26746","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2690.10,"maximum":2989.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2989.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2839.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2690.10,"methodology":"fee schedule"}]}]},{"description":"Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approaches SCHEDULED","code_information":[{"code":"21344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments SCHEDULED","code_information":[{"code":"25608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4986.00,"maximum":5540.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5540.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5263.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4986.00,"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 fibula only SCHEDULED","code_information":[{"code":"27826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21949.20,"maximum":24388.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":24388.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":23168.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":21949.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when performed SCHEDULED","code_information":[{"code":"28505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4883.40,"maximum":5426.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5154.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4883.40,"methodology":"fee schedule"}]}]},{"description":"Open treatment of greater trochanteric fracture, includes internal fixation, when performed SCHEDULED","code_information":[{"code":"27248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12077.10,"maximum":13419.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":13419.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":12748.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":12077.10,"methodology":"fee schedule"}]}]},{"description":"Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed SCHEDULED","code_information":[{"code":"24575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12429.00,"maximum":13810.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":13810.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":13119.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":12429.00,"methodology":"fee schedule"}]}]},{"description":"Open treatment of metatarsal fracture, includes internal fixation, when performed, each UNSCHEDULED","code_information":[{"code":"28485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5885.10,"maximum":6539.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6539.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6212.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5885.10,"methodology":"fee schedule"}]}]},{"description":"Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft) UNSCHEDULED","code_information":[{"code":"21348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4654.80,"maximum":5172.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5172.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4913.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4654.80,"methodology":"fee schedule"}]}]},{"description":"Open treatment of orbital floor blowout fracture; periorbital approach UNSCHEDULED","code_information":[{"code":"21386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5546.70,"maximum":6163.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6163.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5854.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5546.70,"methodology":"fee schedule"}]}]},{"description":"Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed UNSCHEDULED","code_information":[{"code":"27784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11286.90,"maximum":12541.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":12541.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":11913.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":11286.90,"methodology":"fee schedule"}]}]},{"description":"Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribs UNSCHEDULED","code_information":[{"code":"21811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4923.90,"maximum":5471.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5471.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5197.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4923.90,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, elbow, surgical; with removal of loose body or foreign body UNSCHEDULED","code_information":[{"code":"29834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5583.60,"maximum":6204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5893.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5583.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture SCHEDULED","code_information":[{"code":"29879","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1899.00,"maximum":2110.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2110.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2004.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1899.00,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion UNSCHEDULED","code_information":[{"code":"29886","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5583.60,"maximum":6204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5893.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5583.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograftºs») UNSCHEDULED","code_information":[{"code":"29866","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5583.60,"maximum":6204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5893.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5583.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, shoulder, surgical; capsulorrhaphy UNSCHEDULED","code_information":[{"code":"29806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15176.70,"maximum":16863.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":16863.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":16019.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":15176.70,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, shoulder, surgical; with rotator cuff repair UNSCHEDULED","code_information":[{"code":"29827","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9695.70,"maximum":10773.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":10773.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10234.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":9695.70,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, temporomandibular joint, surgical SCHEDULED","code_information":[{"code":"29804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6665.40,"maximum":7406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7035.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6665.40,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, wrist, surgical; internal fixation for fracture or instability SCHEDULED","code_information":[{"code":"29847","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4361.40,"maximum":4846.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4846.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4603.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4361.40,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure) UNSCHEDULED","code_information":[{"code":"24006","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, elbow, including exploration, drainage, or removal of foreign body SCHEDULED","code_information":[{"code":"24000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6528.60,"maximum":7254.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7254.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6891.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6528.60,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint UNSCHEDULED","code_information":[{"code":"28024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint UNSCHEDULED","code_information":[{"code":"26070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2487.60,"maximum":2764.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2764.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2625.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2487.60,"methodology":"fee schedule"}]}]},{"description":"Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (eg, David Procedure, Yacoub Procedure) UNSCHEDULED","code_information":[{"code":"33864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Aspiration and/or injection, thyroid cyst SCHEDULED","code_information":[{"code":"60300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":370.80,"maximum":412.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":412.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":391.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":370.80,"methodology":"fee schedule"}]}]},{"description":"ASSAY OF DIMETHADIONE UNSCHEDULED","code_information":[{"code":"82654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"ASSAY OF NORTRIPTYLINE UNSCHEDULED","code_information":[{"code":"80182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105.30,"maximum":117.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":117.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":111.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":105.30,"methodology":"fee schedule"}]}]},{"description":"ATHERECTOMY, OPEN SCHEDULED","code_information":[{"code":"35482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Atrial septectomy or septostomy; open heart with cardiopulmonary bypass UNSCHEDULED","code_information":[{"code":"33736","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report UNSCHEDULED","code_information":[{"code":"92651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.20,"maximum":218.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":218.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":207.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":196.20,"methodology":"fee schedule"}]}]},{"description":"Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary p UNSCHEDULED","code_information":[{"code":"20936","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":845.10,"maximum":939.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":939.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":892.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":845.10,"methodology":"fee schedule"}]}]},{"description":"Automated hemogram UNSCHEDULED","code_information":[{"code":"85024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87.30,"maximum":97.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":97.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":92.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":87.30,"methodology":"fee schedule"}]}]},{"description":"b-Hexosaminidase, each assay UNSCHEDULED","code_information":[{"code":"83080","type":"CPT"},{"code":"L000125201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":336.60,"maximum":374.00,"gross_charge":445.75,"discounted_cash":445.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":374.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":355.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":336.60,"methodology":"fee schedule"}]}]},{"description":"Backbench standard preparation of cadaver donor heart allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inferior SCHEDULED","code_information":[{"code":"33944","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Balloon angioplasty, intracranial (eg, atherosclerotic stenosis), percutaneous SCHEDULED","code_information":[{"code":"61630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel SCHEDULED","code_information":[{"code":"61640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative UNSCHEDULED","code_information":[{"code":"81206","type":"CPT"},{"code":"L000048002","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"gross_charge":703.50,"discounted_cash":703.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Beta-2 microglobulin UNSCHEDULED","code_information":[{"code":"82232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":32.40,"maximum":36.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":36.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":34.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":32.40,"methodology":"fee schedule"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) without stent SCHEDULED","code_information":[{"code":"47555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Biopsy of anorectal wall, anal approach (eg, congenital megacolon) UNSCHEDULED","code_information":[{"code":"45100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Biopsy of liver, needle; percutaneous SCHEDULED","code_information":[{"code":"47000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418.40,"maximum":1576.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1576.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1497.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1418.40,"methodology":"fee schedule"}]}]},{"description":"Biopsy of salivary gland; incisional UNSCHEDULED","code_information":[{"code":"42405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3762.90,"maximum":4181.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4181.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3971.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3762.90,"methodology":"fee schedule"}]}]},{"description":"Biopsy of testis, needle (separate procedure) SCHEDULED","code_information":[{"code":"54500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5758.20,"maximum":6398.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6398.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6078.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5758.20,"methodology":"fee schedule"}]}]},{"description":"Biopsy of tongue; posterior one-third UNSCHEDULED","code_information":[{"code":"41105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1944.00,"maximum":2160.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2160.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2052.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1944.00,"methodology":"fee schedule"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"56606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5367.60,"maximum":5964.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5964.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5665.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5367.60,"methodology":"fee schedule"}]}]},{"description":"Biopsy, abdominal or retroperitoneal mass, percutaneous needle SCHEDULED","code_information":[{"code":"49180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2312.10,"maximum":2569.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2569.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2440.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2312.10,"methodology":"fee schedule"}]}]},{"description":"Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including m SCHEDULED","code_information":[{"code":"19085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3659.40,"maximum":4066.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4066.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3862.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3659.40,"methodology":"fee schedule"}]}]},{"description":"Biopsy, intranasal SCHEDULED","code_information":[{"code":"30100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of leg or ankle area; superficial SCHEDULED","code_information":[{"code":"27613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9572.40,"maximum":10636.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":10636.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10104.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":9572.40,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; superficial UNSCHEDULED","code_information":[{"code":"27323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of upper arm or elbow area; superficial UNSCHEDULED","code_information":[{"code":"24065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Blood count; leukocyte (WBC), automated UNSCHEDULED","code_information":[{"code":"85048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180.90,"maximum":201.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":201.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":190.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":180.90,"methodology":"fee schedule"}]}]},{"description":"Blood count; reticulocytes, automated, including 1 or more cellular parameters (eg, reticulocyte hemoglobin content ºCHr», immature reticulocyte fraction ºIRF», reticulocyte volume ºMRV», RNA content) UNSCHEDULED","code_information":[{"code":"85046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":68.40,"maximum":76.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":76.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":72.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":68.40,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened UNSCHEDULED","code_information":[{"code":"86904","type":"CPT"},{"code":"L000328001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":54.00,"maximum":60.00,"gross_charge":151.00,"discounted_cash":151.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":60.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":57.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":54.00,"methodology":"fee schedule"}]}]},{"description":"Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal UNSCHEDULED","code_information":[{"code":"20962","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":845.10,"maximum":939.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":939.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":892.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":845.10,"methodology":"fee schedule"}]}]},{"description":"Bone graft, any donor area; major or large UNSCHEDULED","code_information":[{"code":"20902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":845.10,"maximum":939.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":939.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":892.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":845.10,"methodology":"fee schedule"}]}]},{"description":"Bone marrow imaging; whole body UNSCHEDULED","code_information":[{"code":"78104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Bradykinin UNSCHEDULED","code_information":[{"code":"82286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"BRAIN SURGERY USING COMPUTER UNSCHEDULED","code_information":[{"code":"61795","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Breast augmentation with implant SCHEDULED","code_information":[{"code":"19325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3659.40,"maximum":4066.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4066.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3862.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3659.40,"methodology":"fee schedule"}]}]},{"description":"Breathing response to hypoxia (hypoxia response curve) UNSCHEDULED","code_information":[{"code":"94450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2155.50,"maximum":2395.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2395.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2275.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2155.50,"methodology":"fee schedule"}]}]},{"description":"BRONCHOSCOPY INJ FOR X-RAY SCHEDULED","code_information":[{"code":"31656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2890.80,"maximum":3212.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3212.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3051.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2890.80,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), initial lobe SCHEDULED","code_information":[{"code":"31648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2890.80,"maximum":3212.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3212.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3051.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2890.80,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as req SCHEDULED","code_information":[{"code":"31638","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2890.80,"maximum":3212.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3212.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3051.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2890.80,"methodology":"fee schedule"}]}]},{"description":"Buprenorphine UNSCHEDULED","code_information":[{"code":"80348","type":"CPT"},{"code":"L000032802","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":207.90,"maximum":231.00,"gross_charge":42.75,"discounted_cash":42.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":231.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":219.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":207.90,"methodology":"fee schedule"}]}]},{"description":"Burr hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s), pressure recording device, or other cerebral monitoring device (separate procedure) UNSCHEDULED","code_information":[{"code":"61210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; axillary-femoral SCHEDULED","code_information":[{"code":"35621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; femoral-femoral UNSCHEDULED","code_information":[{"code":"35661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; splenorenal (splenic to renal arterial anastomosis) UNSCHEDULED","code_information":[{"code":"35636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; aortobifemoral UNSCHEDULED","code_information":[{"code":"35540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; aortorenal SCHEDULED","code_information":[{"code":"35560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels SCHEDULED","code_information":[{"code":"35566","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; iliofemoral UNSCHEDULED","code_information":[{"code":"35565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; splenorenal SCHEDULED","code_information":[{"code":"35536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Caffeine UNSCHEDULED","code_information":[{"code":"80155","type":"CPT"},{"code":"L000002101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":105.30,"maximum":117.00,"gross_charge":374.25,"discounted_cash":374.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":117.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":111.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":105.30,"methodology":"fee schedule"}]}]},{"description":"Calcium; urine quantitative, timed specimen UNSCHEDULED","code_information":[{"code":"82340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Capsulodesis, metacarpophalangeal joint; 2 digits SCHEDULED","code_information":[{"code":"26517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4054.50,"maximum":4505.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4505.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4054.50,"methodology":"fee schedule"}]}]},{"description":"Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, UNSCHEDULED","code_information":[{"code":"94781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Cardiac shunt detection UNSCHEDULED","code_information":[{"code":"78428","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and re SCHEDULED","code_information":[{"code":"93015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"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 UNSCHEDULED","code_information":[{"code":"93460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14265.90,"maximum":15851.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":15851.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15058.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14265.90,"methodology":"fee schedule"}]}]},{"description":"Central motor evoked potential study (transcranial motor stimulation); lower limbs SCHEDULED","code_information":[{"code":"95929","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":144.90,"maximum":161.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":161.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":152.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":144.90,"methodology":"fee schedule"}]}]},{"description":"Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation UNSCHEDULED","code_information":[{"code":"78645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"CHANGE BILE DUCT CATHETER SCHEDULED","code_information":[{"code":"47525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Chemical peel, nonfacial; epidermal UNSCHEDULED","code_information":[{"code":"15792","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"Chemotaxis assay, specify method UNSCHEDULED","code_information":[{"code":"86155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration into pleural cavity, requiring and including thoracentesis UNSCHEDULED","code_information":[{"code":"96440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":635.40,"maximum":706.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":706.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":670.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":635.40,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"96423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration; intralesional, more than 7 lesions UNSCHEDULED","code_information":[{"code":"96406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":635.40,"maximum":706.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":706.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":670.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":635.40,"methodology":"fee schedule"}]}]},{"description":"Chloride; other source UNSCHEDULED","code_information":[{"code":"82438","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Cholecystoenterostomy; Roux-en-Y UNSCHEDULED","code_information":[{"code":"47740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1163.70,"maximum":1293.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1293.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1228.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1163.70,"methodology":"fee schedule"}]}]},{"description":"Chorionic villus sampling, any method SCHEDULED","code_information":[{"code":"59015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":274.50,"maximum":305.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":305.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":289.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":274.50,"methodology":"fee schedule"}]}]},{"description":"Cineradiography/videoradiography to complement routine examination (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"76125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.90,"maximum":561.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":561.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":532.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":504.90,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of acromioclavicular dislocation; without manipulation UNSCHEDULED","code_information":[{"code":"23540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":647.10,"maximum":719.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":719.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":683.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":647.10,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation UNSCHEDULED","code_information":[{"code":"27810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":889.20,"maximum":988.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":988.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":938.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":889.20,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of coccygeal fracture UNSCHEDULED","code_information":[{"code":"27200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of distal fibular fracture (lateral malleolus); with manipulation SCHEDULED","code_information":[{"code":"27788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5598.00,"maximum":6220.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6220.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5909.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5598.00,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each SCHEDULED","code_information":[{"code":"26750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4054.50,"maximum":4505.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4505.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4054.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation SCHEDULED","code_information":[{"code":"27508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of femoral fracture, proximal end, head; without manipulation UNSCHEDULED","code_information":[{"code":"27267","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction UNSCHEDULED","code_information":[{"code":"27502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of fracture great toe, phalanx or phalanges; without manipulation SCHEDULED","code_information":[{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of greater humeral tuberosity fracture; with manipulation SCHEDULED","code_information":[{"code":"23625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6361.20,"maximum":7068.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7068.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6714.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6361.20,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of humeral condylar fracture, medial or lateral; without manipulation UNSCHEDULED","code_information":[{"code":"24576","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":304.20,"maximum":338.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":338.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":321.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":304.20,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of interphalangeal joint dislocation; requiring anesthesia SCHEDULED","code_information":[{"code":"28665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation UNSCHEDULED","code_information":[{"code":"27238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia SCHEDULED","code_information":[{"code":"26705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4054.50,"maximum":4505.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4505.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4054.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of metatarsal fracture; without manipulation, each SCHEDULED","code_information":[{"code":"28470","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulation UNSCHEDULED","code_information":[{"code":"24620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":870.30,"maximum":967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":918.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":870.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of proximal fibula or shaft fracture; without manipulation UNSCHEDULED","code_information":[{"code":"27780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":365.40,"maximum":406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":385.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":365.40,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of radial head or neck fracture; without manipulation UNSCHEDULED","code_information":[{"code":"24650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":369.00,"maximum":410.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":410.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":389.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":369.00,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of sesamoid fracture UNSCHEDULED","code_information":[{"code":"28530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of sternoclavicular dislocation; without manipulation UNSCHEDULED","code_information":[{"code":"23520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia UNSCHEDULED","code_information":[{"code":"28540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of ulnar shaft fracture; with manipulation SCHEDULED","code_information":[{"code":"25535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction UNSCHEDULED","code_information":[{"code":"22315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Closure of laceration, vestibule of mouth; 2.5 cm or less UNSCHEDULED","code_information":[{"code":"40830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":557.10,"maximum":619.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":619.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":588.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":557.10,"methodology":"fee schedule"}]}]},{"description":"Closure of multiple ventricular septal defects; with removal of pulmonary artery band, with or without gusset UNSCHEDULED","code_information":[{"code":"33677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Closure of rectovaginal fistula; abdominal approach SCHEDULED","code_information":[{"code":"57305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Closure of rectovesical fistula; with colostomy UNSCHEDULED","code_information":[{"code":"45805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1649.70,"maximum":1833.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1833.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1741.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1649.70,"methodology":"fee schedule"}]}]},{"description":"Closure of vesicouterine fistula; SCHEDULED","code_information":[{"code":"51920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"CMPLX RPR E/N/E/L 1.0 CM/< UNSCHEDULED","code_information":[{"code":"13150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"Coccygectomy, primary SCHEDULED","code_information":[{"code":"27080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6219.00,"maximum":6910.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6910.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6564.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6219.00,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; with coloproctostomy (low pelvic anastomosis) SCHEDULED","code_information":[{"code":"44145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) UNSCHEDULED","code_information":[{"code":"44388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed SCHEDULED","code_information":[{"code":"44408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with endoscopic ultrasound examination, limited to the sigmoid, descending, transverse, or ascending colon and cecum and adjacent structures UNSCHEDULED","code_information":[{"code":"44406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/STENT SCHEDULED","code_information":[{"code":"45387","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures SCHEDULED","code_information":[{"code":"45391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with transendoscopic balloon dilation SCHEDULED","code_information":[{"code":"45386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2122.20,"maximum":2358.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2358.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2240.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2122.20,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral UNSCHEDULED","code_information":[{"code":"29868","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5583.60,"maximum":6204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5893.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5583.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; with lateral release SCHEDULED","code_information":[{"code":"29873","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2719.80,"maximum":3022.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3022.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2870.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2719.80,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s SCHEDULED","code_information":[{"code":"29880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3090.60,"maximum":3434.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3434.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3262.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3090.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps ancho UNSCHEDULED","code_information":[{"code":"29822","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5583.60,"maximum":6204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5893.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5583.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis UNSCHEDULED","code_information":[{"code":"29907","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5583.60,"maximum":6204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5893.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5583.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, subtalar joint, surgical; with synovectomy UNSCHEDULED","code_information":[{"code":"29905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5583.60,"maximum":6204.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6204.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5893.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5583.60,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy with meniscus repair, knee UNSCHEDULED","code_information":[{"code":"27403","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, elbow; with synovectomy UNSCHEDULED","code_information":[{"code":"24102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign body SCHEDULED","code_information":[{"code":"23040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6361.20,"maximum":7068.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7068.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6714.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6361.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies UNSCHEDULED","code_information":[{"code":"27331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, with synovectomy, ankle; including tenosynovectomy SCHEDULED","code_information":[{"code":"27626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5364.00,"maximum":5960.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5960.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5662.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5364.00,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body UNSCHEDULED","code_information":[{"code":"25101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3509.10,"maximum":3899.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3899.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3704.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3509.10,"methodology":"fee schedule"}]}]},{"description":"ASCENDING AORTIC GRAFT SCHEDULED","code_information":[{"code":"33861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous UNSCHEDULED","code_information":[{"code":"50390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"ASSAY OF BARBITURATES UNSCHEDULED","code_information":[{"code":"82205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"ASSAY OF DOXEPIN UNSCHEDULED","code_information":[{"code":"80166","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":105.30,"maximum":117.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":117.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":111.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":105.30,"methodology":"fee schedule"}]}]},{"description":"ASSAY OF METHADONE UNSCHEDULED","code_information":[{"code":"83840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"ASSAY OF URINE ALKALOIDS UNSCHEDULED","code_information":[{"code":"82101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Assembly and operation of pump with oxygenator or heat exchanger (with or without ECG and/or pressure monitoring); each hour UNSCHEDULED","code_information":[{"code":"99190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":108.90,"maximum":121.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":121.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":114.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":108.90,"methodology":"fee schedule"}]}]},{"description":"ASXL1 (additional sex combs like 1, transcriptional regulator) (eg, myelodysplastic syndrome, myeloproliferative neoplasms, chronic myelomonocytic leukemia), gene analysis; targeted sequence analysis UNSCHEDULED","code_information":[{"code":"81176","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Atomic absorption spectroscopy, each analyte UNSCHEDULED","code_information":[{"code":"82190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Auditory evoked potentials; neurodiagnostic, with interpretation and report UNSCHEDULED","code_information":[{"code":"92653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.20,"maximum":218.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":218.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":207.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":196.20,"methodology":"fee schedule"}]}]},{"description":"Automated hemogram UNSCHEDULED","code_information":[{"code":"85023","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":87.30,"maximum":97.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":97.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":92.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":87.30,"methodology":"fee schedule"}]}]},{"description":"B CELLS, TOTAL COUNT UNSCHEDULED","code_information":[{"code":"86064","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use UNSCHEDULED","code_information":[{"code":"90586","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Backbench standard preparation of cadaver donor heart/lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare aorta, superior vena cava, inf UNSCHEDULED","code_information":[{"code":"33933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision o SCHEDULED","code_information":[{"code":"50323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potass UNSCHEDULED","code_information":[{"code":"80047","type":"CPT"},{"code":"L000000301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":210.60,"maximum":234.00,"gross_charge":260.75,"discounted_cash":260.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":234.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":222.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":210.60,"methodology":"fee schedule"}]}]},{"description":"Behavioral and qualitative analysis of voice and resonance UNSCHEDULED","code_information":[{"code":"92524","type":"CPT"},{"code":"T000026901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"gross_charge":1890.00,"discounted_cash":1890.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Biofeedback training by any modality SCHEDULED","code_information":[{"code":"90901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41.40,"maximum":46.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":41.40,"methodology":"fee schedule"}]}]},{"description":"Biopsy of intestine by capsule, tube, peroral (1 or more specimens) UNSCHEDULED","code_information":[{"code":"44100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Biopsy of testis, incisional (separate procedure) SCHEDULED","code_information":[{"code":"54505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5758.20,"maximum":6398.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6398.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6078.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5758.20,"methodology":"fee schedule"}]}]},{"description":"BIOPSY THROUGH CHEST WALL SCHEDULED","code_information":[{"code":"32095","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2166.30,"maximum":2407.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2286.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2166.30,"methodology":"fee schedule"}]}]},{"description":"Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) SCHEDULED","code_information":[{"code":"20225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2087.10,"maximum":2319.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2203.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2087.10,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) SCHEDULED","code_information":[{"code":"25066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of thigh or knee area; superficial SCHEDULED","code_information":[{"code":"27323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Biotinidase, each specimen UNSCHEDULED","code_information":[{"code":"82261","type":"CPT"},{"code":"L000089701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"gross_charge":466.25,"discounted_cash":466.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Blood bank physician services; authorization for deviation from standard blood banking procedures (eg, use of outdated blood, transfusion of Rh incompatible units), with written report UNSCHEDULED","code_information":[{"code":"86079","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Blood typing, for paternity testing, per individual; ABO, Rh and MN UNSCHEDULED","code_information":[{"code":"86910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70.20,"maximum":78.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":78.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":74.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":70.20,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; Rh (D) UNSCHEDULED","code_information":[{"code":"86901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41.40,"maximum":46.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":46.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":41.40,"methodology":"fee schedule"}]}]},{"description":"Bone and/or joint imaging; 3 phase study UNSCHEDULED","code_information":[{"code":"78315","type":"CPT"},{"code":"I000165401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"gross_charge":5655.75,"discounted_cash":5655.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Bone and/or joint imaging; multiple areas UNSCHEDULED","code_information":[{"code":"78305","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry UNSCHEDULED","code_information":[{"code":"78350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Bone marrow imaging; limited area UNSCHEDULED","code_information":[{"code":"78102","type":"CPT"},{"code":"I000161501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"gross_charge":1703.00,"discounted_cash":1703.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if SCHEDULED","code_information":[{"code":"31634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1485.00,"maximum":1650.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1650.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1567.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1485.00,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with excision of tumor UNSCHEDULED","code_information":[{"code":"31640","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2259.90,"maximum":2511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2385.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2259.90,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fracture SCHEDULED","code_information":[{"code":"31630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3903.30,"maximum":4337.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4337.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4120.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3903.30,"methodology":"fee schedule"}]}]},{"description":"Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material) UNSCHEDULED","code_information":[{"code":"61120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Burr hole(s); with aspiration of hematoma or cyst, intracerebral SCHEDULED","code_information":[{"code":"61156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal UNSCHEDULED","code_information":[{"code":"35631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; axillary-popliteal or -tibial UNSCHEDULED","code_information":[{"code":"35623","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with other than vein; ilioiliac SCHEDULED","code_information":[{"code":"35663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; aortoiliac UNSCHEDULED","code_information":[{"code":"35537","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; brachial-ulnar or -radial UNSCHEDULED","code_information":[{"code":"35523","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; femoral-popliteal UNSCHEDULED","code_information":[{"code":"35556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft, with vein; subclavian-axillary UNSCHEDULED","code_information":[{"code":"35516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Bypass graft; autogenous composite, 3 or more segments of vein from 2 or more locations (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"35683","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg, spinocerebellar ataxia) gene analysis; full gene sequence UNSCHEDULED","code_information":[{"code":"81185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Calculus; infrared spectroscopy UNSCHEDULED","code_information":[{"code":"82365","type":"CPT"},{"code":"L000091202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":35.10,"maximum":39.00,"gross_charge":54.00,"discounted_cash":54.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":39.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":35.10,"methodology":"fee schedule"}]}]},{"description":"Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint UNSCHEDULED","code_information":[{"code":"26520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Capsulodesis, metacarpophalangeal joint; single digit SCHEDULED","code_information":[{"code":"26516","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5232.60,"maximum":5814.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5814.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5523.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5232.60,"methodology":"fee schedule"}]}]},{"description":"Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block UNSCHEDULED","code_information":[{"code":"23465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"Capsulotomy, wrist (eg, contracture) SCHEDULED","code_information":[{"code":"25085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2242.80,"maximum":2492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2367.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2242.80,"methodology":"fee schedule"}]}]},{"description":"Car seat/bed testing for airway integrity, for infants through 12 months of age, with continual clinical staff observation and continuous recording of pulse oximetry, heart rate and respiratory rate, UNSCHEDULED","code_information":[{"code":"94780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Cardiopulmonary resuscitation (eg, in cardiac arrest) SCHEDULED","code_information":[{"code":"92950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195.30,"maximum":217.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":217.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":206.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":195.30,"methodology":"fee schedule"}]}]},{"description":"Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure) SCHEDULED","code_information":[{"code":"92961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":265.50,"maximum":295.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":295.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":280.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":265.50,"methodology":"fee schedule"}]}]},{"description":"Catecholamines; fractionated UNSCHEDULED","code_information":[{"code":"82384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.20,"maximum":28.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":25.20,"methodology":"fee schedule"}]}]},{"description":"Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography UNSCHEDULED","code_information":[{"code":"78635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Change of cystostomy tube; simple UNSCHEDULED","code_information":[{"code":"51705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":411.30,"maximum":457.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":457.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":434.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":411.30,"methodology":"fee schedule"}]}]},{"description":"Chemodenervation of eccrine glands; both axillae SCHEDULED","code_information":[{"code":"64650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Chemodenervation of one extremity; each additional extremity, 5 or more muscles (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"64645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Chemodenervation of trunk muscle(s); 6 or more muscles SCHEDULED","code_information":[{"code":"64647","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture UNSCHEDULED","code_information":[{"code":"96450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":635.40,"maximum":706.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":706.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":670.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":635.40,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure) SCHEDULED","code_information":[{"code":"96417","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump SCHEDULED","code_information":[{"code":"96416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135.00,"maximum":150.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":142.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":135.00,"methodology":"fee schedule"}]}]},{"description":"Chiropractic manipulative treatment (CMT); spinal, 3-4 regions SCHEDULED","code_information":[{"code":"98941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35.10,"maximum":39.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":39.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":35.10,"methodology":"fee schedule"}]}]},{"description":"Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; with transduodenal sphincterotomy or sphincteroplasty UNSCHEDULED","code_information":[{"code":"47425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1163.70,"maximum":1293.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1293.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1228.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1163.70,"methodology":"fee schedule"}]}]},{"description":"Cholinesterase; RBC UNSCHEDULED","code_information":[{"code":"82482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.30,"maximum":17.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":15.30,"methodology":"fee schedule"}]}]},{"description":"Chorionic gonadotropin stimulation panel; testosterone response This panel must include the following: Testosterone (84403 x 2 on 3 pooled blood samples) UNSCHEDULED","code_information":[{"code":"80414","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118.80,"maximum":132.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":132.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":125.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":118.80,"methodology":"fee schedule"}]}]},{"description":"Ciliary body destruction; cryotherapy UNSCHEDULED","code_information":[{"code":"66720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Cineradiography/videoradiography, except where specifically included UNSCHEDULED","code_information":[{"code":"76120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.90,"maximum":561.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":561.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":532.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":504.90,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or without skeletal traction SCHEDULED","code_information":[{"code":"27222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8869.50,"maximum":9855.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9855.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9362.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8869.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid ºnavicular»); with manipulation, each bone SCHEDULED","code_information":[{"code":"25635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of coccygeal fracture SCHEDULED","code_information":[{"code":"27200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8869.50,"maximum":9855.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9855.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9362.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8869.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger) SCHEDULED","code_information":[{"code":"26432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4743.90,"maximum":5271.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5271.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5007.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4743.90,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of femoral fracture, proximal end, head; with manipulation UNSCHEDULED","code_information":[{"code":"27268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of femoral shaft fracture, without manipulation UNSCHEDULED","code_information":[{"code":"27500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of greater humeral tuberosity fracture; without manipulation SCHEDULED","code_information":[{"code":"23620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6361.20,"maximum":7068.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7068.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6714.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6361.20,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of hip dislocation, traumatic; requiring anesthesia SCHEDULED","code_information":[{"code":"27252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8869.50,"maximum":9855.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9855.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9362.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8869.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction UNSCHEDULED","code_information":[{"code":"24505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":954.00,"maximum":1060.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1060.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1007.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":954.00,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of nasal bone fracture with manipulation; with stabilization SCHEDULED","code_information":[{"code":"21320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3988.80,"maximum":4432.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4432.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4210.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3988.80,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia UNSCHEDULED","code_information":[{"code":"27266","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1125.90,"maximum":1251.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1251.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1188.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1125.90,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of posterior malleolus fracture; with manipulation UNSCHEDULED","code_information":[{"code":"27768","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2155.50,"maximum":2395.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2395.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2275.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2155.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of sternoclavicular dislocation; with manipulation UNSCHEDULED","code_information":[{"code":"23525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of ulnar styloid fracture SCHEDULED","code_information":[{"code":"25650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5115.60,"maximum":5684.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5684.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5399.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5115.60,"methodology":"fee schedule"}]}]},{"description":"Closure of enterostomy, large or small intestine; UNSCHEDULED","code_information":[{"code":"44620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Closure of gastrocolic fistula SCHEDULED","code_information":[{"code":"43880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6477.30,"maximum":7197.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7197.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6837.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6477.30,"methodology":"fee schedule"}]}]},{"description":"Closure of rectovesical fistula; with colostomy SCHEDULED","code_information":[{"code":"45805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery SCHEDULED","code_information":[{"code":"68760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1697.40,"maximum":1886.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1886.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1791.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1697.40,"methodology":"fee schedule"}]}]},{"description":"Closure of urethrovaginal fistula; with bulbocavernosus transplant SCHEDULED","code_information":[{"code":"57311","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, activity UNSCHEDULED","code_information":[{"code":"85300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":104.40,"maximum":116.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":116.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":110.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":104.40,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor VII (proconvertin, stable factor) UNSCHEDULED","code_information":[{"code":"85230","type":"CPT"},{"code":"L000201401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":27.90,"maximum":31.00,"gross_charge":671.75,"discounted_cash":671.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":31.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":27.90,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor XIII (fibrin stabilizing), screen solubility UNSCHEDULED","code_information":[{"code":"85291","type":"CPT"},{"code":"L000202601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":87.30,"maximum":97.00,"gross_charge":244.25,"discounted_cash":244.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":97.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":92.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":87.30,"methodology":"fee schedule"}]}]},{"description":"Colectomy, partial; abdominal and transanal approach SCHEDULED","code_information":[{"code":"44147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed UNSCHEDULED","code_information":[{"code":"44157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with biopsy, single or multiple UNSCHEDULED","code_information":[{"code":"44389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with directed submucosal injection(s), any substance UNSCHEDULED","code_information":[{"code":"44404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) UNSCHEDULED","code_information":[{"code":"44402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"COLONOSCOPY W/STENT SCHEDULED","code_information":[{"code":"44397","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique SCHEDULED","code_information":[{"code":"45385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1544.40,"maximum":1716.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1716.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1630.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1544.40,"methodology":"fee schedule"}]}]},{"description":"Colostomy or skin level cecostomy; with multiple biopsies (eg, for congenital megacolon) (separate procedure) UNSCHEDULED","code_information":[{"code":"44322","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Colpotomy; with exploration SCHEDULED","code_information":[{"code":"57000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; SCHEDULED","code_information":[{"code":"57260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8444.70,"maximum":9383.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9383.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8913.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8444.70,"methodology":"fee schedule"}]}]},{"description":"Comp unusual REP >7.5 cm UNSCHEDULED","code_information":[{"code":"13300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"Complement; functional activity, each component UNSCHEDULED","code_information":[{"code":"86161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":45.00,"maximum":50.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":50.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":47.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":45.00,"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 SCHEDULED","code_information":[{"code":"99489","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26.10,"maximum":29.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":29.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":26.10,"methodology":"fee schedule"}]}]},{"description":"Complex uroflowmetry (eg, calibrated electronic equipment) UNSCHEDULED","code_information":[{"code":"51741","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording a UNSCHEDULED","code_information":[{"code":"93654","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28297.80,"maximum":31442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":31442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":29869.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":28297.80,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing UNSCHEDULED","code_information":[{"code":"73206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2521.80,"maximum":2802.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2802.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2661.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2521.80,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, head or brain; with contrast material(s) UNSCHEDULED","code_information":[{"code":"70460","type":"CPT"},{"code":"I000063401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2934.90,"maximum":3261.00,"gross_charge":10919.00,"discounted_cash":10919.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3261.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3097.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2934.90,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lumbar spine; without contrast material UNSCHEDULED","code_information":[{"code":"72131","type":"CPT"},{"code":"I000077601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2059.20,"maximum":2288.00,"gross_charge":10301.50,"discounted_cash":10301.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2288.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2173.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2059.20,"methodology":"fee schedule"}]}]},{"description":"Conditioning play audiometry SCHEDULED","code_information":[{"code":"92582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":70.20,"maximum":78.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":78.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":74.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":70.20,"methodology":"fee schedule"}]}]},{"description":"Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube UNSCHEDULED","code_information":[{"code":"68745","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2344.50,"maximum":2605.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2605.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2474.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2344.50,"methodology":"fee schedule"}]}]},{"description":"Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure) UNSCHEDULED","code_information":[{"code":"49424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":485.10,"maximum":539.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":539.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":512.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":485.10,"methodology":"fee schedule"}]}]},{"description":"CONTRAST X-RAY OF LARYNX UNSCHEDULED","code_information":[{"code":"70373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1961.10,"maximum":2179.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2179.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2070.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1961.10,"methodology":"fee schedule"}]}]},{"description":"Coronary artery bypass, vein only; 2 coronary venous grafts UNSCHEDULED","code_information":[{"code":"33511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"CORONARY ARTERY DILATION UNSCHEDULED","code_information":[{"code":"92984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7257.60,"maximum":8064.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8064.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7660.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7257.60,"methodology":"fee schedule"}]}]},{"description":"Correction of lid retraction UNSCHEDULED","code_information":[{"code":"67911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239.30,"maximum":1377.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1377.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1239.30,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method SCHEDULED","code_information":[{"code":"28296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4925.70,"maximum":5473.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5473.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5199.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4925.70,"methodology":"fee schedule"}]}]},{"description":"Craniectomy or craniotomy for evacuation of hematoma, supratentorial; intracerebral SCHEDULED","code_information":[{"code":"61313","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":" Emergency Room General Classification  ","code_information":[{"code":"450","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":660.00,"maximum":5397.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":3150.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":2592.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":660.00,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":660.00,"methodology":"case rate"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":825.00,"methodology":"case rate"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"case rate"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":895.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":5397.00,"methodology":"case rate"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":745.00,"methodology":"case rate"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":745.00,"methodology":"case rate"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":5397.00,"methodology":"case rate"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":850.00,"methodology":"case rate"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":800.00,"methodology":"case rate"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":700.00,"methodology":"case rate"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":847.00,"methodology":"case rate"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":750.00,"methodology":"case rate"}]}]},{"description":"AbobotulinumtoxinA ","code_information":[{"code":"1289","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":8.63,"maximum":10.36,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.63,"methodology":"fee schedule"}]}]},{"description":"Acetylcholinesterase ","code_information":[{"code":"82013","type":"CPT"},{"code":"L000082201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.14,"maximum":14.75,"gross_charge":315.75,"discounted_cash":315.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.29,"methodology":"fee schedule"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC ","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":117399.47,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21094.24,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21608.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21814.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":33061.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":42006.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":33061.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20785.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20785.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":47648.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":73280.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":47648.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":33061.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22637.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":117399.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":48603.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":117399.47,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21814.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":40150.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20991.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21608.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22020.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19962.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21608.74,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":21814.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25724.69,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17753.45,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22637.73,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":21608.74,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22740.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20991.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":52910.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19591.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20579.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22740.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20168.15,"methodology":"fee schedule"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC ","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":29155.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5878.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6021.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6079.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7086.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9003.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7086.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5792.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5792.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10212.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":15706.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10212.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7086.30,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6308.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29155.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12070.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29155.37,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6079.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":9971.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5849.73,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6021.78,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6136.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5562.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6021.78,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6079.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7168.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4408.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6308.53,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6021.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6337.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5849.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5459.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5735.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6337.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5620.33,"methodology":"fee schedule"}]}]},{"description":"Acylcarnitines; quantitative, each specimen ","code_information":[{"code":"82017","type":"CPT"},{"code":"L000082401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.29,"maximum":20.24,"gross_charge":466.25,"discounted_cash":466.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.87,"methodology":"fee schedule"}]}]},{"description":"Administration set, with small volume nonfiltered pneumatic nebulizer, disposable ","code_information":[{"code":"A7003","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":2.68,"maximum":3.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.83,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.76,"methodology":"fee schedule"}]}]},{"description":"Aerosol compressor, adjustable pressure, light duty for intermittent use ","code_information":[{"code":"E0572","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":41.29,"maximum":51.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":45.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":43.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":43.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":43.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":41.29,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":46.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":48.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":42.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.57,"methodology":"fee schedule"}]}]},{"description":"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC ","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":48949.04,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9291.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9518.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9608.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8726.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11087.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8726.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9155.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9155.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12576.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19341.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12576.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8726.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9971.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48949.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20264.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48949.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9608.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16740.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9246.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9518.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9699.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8792.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9518.03,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9608.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11330.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7402.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9971.26,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9518.03,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10016.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9246.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8629.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9064.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10016.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8883.49,"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":28.56,"maximum":35.33,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":31.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":32.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":31.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":32.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":28.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35.33,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":32.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":33.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":29.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29.44,"methodology":"fee schedule"}]}]},{"description":"Albumin; urine (eg, microalbumin), quantitative ","code_information":[{"code":"82043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.24,"maximum":6.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.78,"methodology":"fee schedule"}]}]},{"description":"Aldesleukin injection ","code_information":[{"code":"807","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3943.00,"maximum":4731.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4041.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4219.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4179.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4021.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4021.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4337.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4219.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4337.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4021.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4219.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3943.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3943.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4731.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3943.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4337.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4534.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3962.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3943.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4140.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3943.00,"methodology":"fee schedule"}]}]},{"description":"Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each ","code_information":[{"code":"86008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.25,"maximum":21.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.38,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.93,"methodology":"fee schedule"}]}]},{"description":"Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and total AFP (including ratio) ","code_information":[{"code":"82107","type":"CPT"},{"code":"L000084301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":58.37,"maximum":77.29,"gross_charge":1748.75,"discounted_cash":1748.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":58.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":61.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":74.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"}]}]},{"description":"Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient ","code_information":[{"code":"E0781","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":302.27,"maximum":373.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":319.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":333.43,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":330.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":317.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":317.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":342.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":333.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":342.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":317.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":333.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":311.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":311.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":302.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":373.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":311.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":342.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":358.36,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":313.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":311.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":327.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":311.62,"methodology":"fee schedule"}]}]},{"description":"Aminolevulinic acid hcl t ","code_information":[{"code":"7308","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":396.97,"maximum":476.37,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":406.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":424.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":420.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":404.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":404.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":436.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":424.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":436.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":404.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":424.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":396.97,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":396.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":476.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":396.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":436.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":456.52,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":398.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":396.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":416.82,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":396.97,"methodology":"fee schedule"}]}]},{"description":"Amphotericin b liposome i ","code_information":[{"code":"736","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":23.32,"maximum":27.99,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.91,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":23.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":27.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":25.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":26.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.49,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.32,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH ","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":83051.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15171.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15541.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15689.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":36255.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46065.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":36255.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14949.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14949.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":52252.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":80361.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":52252.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":36255.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16281.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":83051.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34383.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":83051.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15689.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":28403.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15097.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15541.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15837.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14357.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15541.74,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15689.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18502.08,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12559.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16281.83,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15541.74,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16355.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15097.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14091.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14801.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16355.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14505.63,"methodology":"fee schedule"}]}]},{"description":"Andrology (infertility), sperm-capacitation assessment of ganglioside GM1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and prob ","code_information":[{"code":"0255U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":30.02,"maximum":37.92,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":33.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":32.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":34.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":32.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":31.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31.60,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":30.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34.76,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":36.34,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":31.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":31.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31.60,"methodology":"fee schedule"}]}]},{"description":"Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit ","code_information":[{"code":"G0439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":105.91,"maximum":154.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":131.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":137.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":136.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":141.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":137.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":141.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":131.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":137.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":128.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":128.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":105.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":154.15,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":128.46,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":141.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":147.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":129.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":128.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":134.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":128.46,"methodology":"fee schedule"}]}]},{"description":"Antibody screen, RBC, each serum technique ","code_information":[{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.28,"maximum":11.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.77,"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":292.72,"maximum":387.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":331.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":342.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":292.72,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":387.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":306.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":355.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":371.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":324.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":339.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":322.96,"methodology":"fee schedule"}]}]},{"description":"Antibody; Blastomyces ","code_information":[{"code":"86612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.69,"maximum":15.48,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.22,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.90,"methodology":"fee schedule"}]}]},{"description":"Antibody; Chlamydia ","code_information":[{"code":"86631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.71,"maximum":14.18,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.12,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.59,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.82,"methodology":"fee schedule"}]}]},{"description":"Antibody; Ehrlichia ","code_information":[{"code":"86666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.22,"maximum":12.22,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.18,"methodology":"fee schedule"}]}]},{"description":"Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) ","code_information":[{"code":"86665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.44,"maximum":21.77,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.14,"methodology":"fee schedule"}]}]},{"description":"Antibody; herpes simplex, non-specific type test ","code_information":[{"code":"86694","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.05,"maximum":17.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"Antibody; HTLV-I ","code_information":[{"code":"86687","type":"CPT"},{"code":"L000302901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.24,"maximum":10.91,"gross_charge":233.00,"discounted_cash":233.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.09,"methodology":"fee schedule"}]}]},{"description":"Antibody; lymphocytic choriomeningitis ","code_information":[{"code":"86727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.67,"maximum":15.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"}]}]},{"description":"Antibody; protozoa, not elsewhere specified ","code_information":[{"code":"86753","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.23,"maximum":14.87,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.39,"methodology":"fee schedule"}]}]},{"description":"Antibody; Shigella ","code_information":[{"code":"86771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.18,"maximum":29.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.19,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":28.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.48,"methodology":"fee schedule"}]}]},{"description":"Antibody; West Nile virus ","code_information":[{"code":"86789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.05,"maximum":17.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"}]}]},{"description":"Antineutrophil cytoplasmic antibody (ANCA); screen, each antibody ","code_information":[{"code":"86036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.92,"maximum":14.46,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"}]}]},{"description":"AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC ","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173955.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":61545.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50265.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":61545.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":50157.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":51491.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":51981.61,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":95902.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":88057.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":36698.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":46626.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":36698.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":49529.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":49529.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":52889.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":81341.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":52889.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":36698.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":53943.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72021.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":51981.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":98007.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":50020.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":51491.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":52472.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":47568.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51491.21,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":51981.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":61299.06,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":43336.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":53943.18,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":51491.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":54188.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":50020.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":114002.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 11. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":46685.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49039.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":54188.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":48058.46,"methodology":"fee schedule"}]}]},{"description":"Apol1 (apolipoprotein l1) (eg, chronic kidney disease), risk variants ","code_information":[{"code":"0355U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes ","code_information":[{"code":"97032","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":12.01,"maximum":14.41,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12.01,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; traction, mechanical ","code_information":[{"code":"97012","type":"CPT"},{"code":"T000049401","type":"CDM"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":11.75,"maximum":14.10,"gross_charge":374.25,"discounted_cash":374.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.92,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.75,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; whirlpool ","code_information":[{"code":"97022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.99,"maximum":19.76,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.47,"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":175.94,"maximum":222.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":196.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":175.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":212.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"}]}]},{"description":"Aripirazole lauroxil 1 mg ","code_information":[{"code":"9470","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3.23,"maximum":3.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.23,"methodology":"fee schedule"}]}]},{"description":"ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X) ","code_information":[{"code":"81200","type":"CPT"},{"code":"L000047402","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":44.89,"maximum":56.70,"gross_charge":2264.75,"discounted_cash":2264.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":48.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":50.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":48.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":48.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":48.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":50.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":56.70,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":44.89,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":51.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":54.34,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":47.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":47.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":49.61,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":47.25,"methodology":"fee schedule"}]}]},{"description":"ATN1 (atrophin 1) (eg, dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81177","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.15,"maximum":164.40,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":140.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":145.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":146.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":164.40,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":130.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":150.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":157.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":137.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"}]}]},{"description":"Auto cell process sys ","code_information":[{"code":"2035","type":"APC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_percentage":38.27,"standard_charge_algorithm":"Reimbursement will be 38.27% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_percentage":36.82,"standard_charge_algorithm":"Reimbursement will be 36.82% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_percentage":38.63,"standard_charge_algorithm":"Reimbursement will be 38.63% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_percentage":43.32,"standard_charge_algorithm":"Reimbursement will be 43.32% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_percentage":39.71,"standard_charge_algorithm":"Reimbursement will be 39.71% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_percentage":41.52,"standard_charge_algorithm":"Reimbursement will be 41.52% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_percentage":36.28,"standard_charge_algorithm":"Reimbursement will be 36.28% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_percentage":37.91,"standard_charge_algorithm":"Reimbursement will be 37.91% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_percentage":36.10,"standard_charge_algorithm":"Reimbursement will be 36.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Azathioprine parenteral ","code_information":[{"code":"887","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":235.67,"maximum":282.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":241.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":252.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":249.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":240.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":240.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":259.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":252.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":259.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":240.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":252.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":235.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":235.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":282.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":235.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":259.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":271.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":236.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":235.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":247.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":235.67,"methodology":"fee schedule"}]}]},{"description":"BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC ","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":103030.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18616.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19070.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19252.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15609.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19833.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15609.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18344.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18344.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22496.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34599.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22496.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15609.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19978.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":103030.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":42654.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":103030.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19252.26,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":35235.90,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18525.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19070.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19433.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17617.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19070.64,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":19252.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22703.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15580.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19978.76,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19070.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":20069.57,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18525.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17290.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18162.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":20069.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17799.26,"methodology":"fee schedule"}]}]},{"description":"BCR/ABL1 (eg, chronic myelogenous leukemia) translocation analysis, major breakpoint, quantitative ","code_information":[{"code":"0040U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371.52,"maximum":491.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":420.15,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":438.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":434.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":450.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":438.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":450.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":438.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":409.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":409.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":371.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":491.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":409.90,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":389.40,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":450.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":471.38,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":411.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":409.90,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":409.90,"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":174.95,"maximum":216.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":184.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":192.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":191.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":183.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":183.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":198.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":192.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":198.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":183.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":192.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":174.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":216.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":198.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":207.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":181.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":180.36,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":189.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":180.36,"methodology":"fee schedule"}]}]},{"description":"Beta 2 Glycoprotein I antibody, each ","code_information":[{"code":"86146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.07,"maximum":30.54,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":23.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"Bile acids; total ","code_information":[{"code":"82239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.52,"maximum":20.54,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.12,"methodology":"fee schedule"}]}]},{"description":"Biofeedback training by any modality ","code_information":[{"code":"90901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38.46,"maximum":47.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":40.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":42.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":40.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":42.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":38.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":47.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":43.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":45.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":39.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":39.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":41.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":39.66,"methodology":"fee schedule"}]}]},{"description":"BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC ","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":76324.91,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14011.80,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14353.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14490.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":17247.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":21913.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":17247.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13806.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13806.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":24857.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":38229.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":24857.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":17247.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15037.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":76324.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31598.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":76324.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14490.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":26102.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13943.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14353.55,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14626.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13259.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14353.55,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14490.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17087.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11542.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15037.06,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":14353.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15105.41,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13943.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13013.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13670.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15105.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13396.65,"methodology":"fee schedule"}]}]},{"description":"Blood count; blood smear, microscopic examination without manual differential WBC count ","code_information":[{"code":"85008","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.10,"maximum":4.12,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3.43,"methodology":"fee schedule"}]}]},{"description":"Blood count; platelet, automated ","code_information":[{"code":"85049","type":"CPT"},{"code":"L000200401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.06,"maximum":5.38,"gross_charge":214.75,"discounted_cash":214.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.26,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.48,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; antigen screening for compatible unit using patient serum, per unit screened ","code_information":[{"code":"86904","type":"CPT"},{"code":"L000328001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.52,"maximum":19.61,"gross_charge":151.00,"discounted_cash":151.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.61,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.52,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.34,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations ","code_information":[{"code":"82274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.43,"maximum":19.10,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.43,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.12,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.92,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by immunoblot, IgM ","code_information":[{"code":"0041U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.35,"maximum":20.65,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.21,"methodology":"fee schedule"}]}]},{"description":"Brachytx, non-stranded, N ","code_information":[{"code":"2699","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":34.95,"maximum":41.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35.65,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":41.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":36.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":34.95,"methodology":"fee schedule"}]}]},{"description":"Brachytx, stranded, P-103 ","code_information":[{"code":"2640","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":76.19,"maximum":91.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":78.09,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":81.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":80.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":77.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":77.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":83.81,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":81.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":83.81,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":77.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":81.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":91.43,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":83.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":87.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":76.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":76.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":80.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":76.19,"methodology":"fee schedule"}]}]},{"description":"BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rea ","code_information":[{"code":"81164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":555.02,"maximum":701.08,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":598.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":625.13,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":619.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":595.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":595.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":642.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":625.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":642.65,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":595.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":625.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":584.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":584.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":701.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":584.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":555.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":642.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":671.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":587.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":584.23,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":613.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":584.23,"methodology":"fee schedule"}]}]},{"description":"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":85321.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15563.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15942.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16094.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7378.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9375.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7378.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15335.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15335.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10634.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16355.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10634.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7378.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16701.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":85321.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":35323.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":85321.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16094.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":29179.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15487.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15942.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16246.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14727.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15942.62,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":16094.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18979.31,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12902.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16701.80,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15942.62,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16777.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15487.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14454.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15183.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16777.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14879.78,"methodology":"fee schedule"}]}]},{"description":"Buprenorphine implant 74. ","code_information":[{"code":"9058","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1311.75,"maximum":1574.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1344.54,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1403.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1390.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1337.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1337.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1442.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1403.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1442.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1337.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1403.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1311.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1311.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1574.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1311.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1442.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1508.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1318.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1311.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1377.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1311.75,"methodology":"fee schedule"}]}]},{"description":"Cabazitaxel injection ","code_information":[{"code":"9276","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":216.46,"maximum":259.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":221.87,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":231.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":229.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":220.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":220.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":238.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":231.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":238.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":220.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":231.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":216.46,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":216.46,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":259.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":216.46,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":238.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":248.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":217.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":216.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":227.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":216.46,"methodology":"fee schedule"}]}]},{"description":"Calcitonin salmon injecti ","code_information":[{"code":"1433","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1173.06,"maximum":1407.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1202.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1255.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1243.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1196.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1196.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1290.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1255.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1290.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1196.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1255.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1173.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1173.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1407.67,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1173.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1290.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1349.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1178.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1173.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1231.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1173.06,"methodology":"fee schedule"}]}]},{"description":"Calculus; qualitative analysis ","code_information":[{"code":"82355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.50,"maximum":13.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.58,"methodology":"fee schedule"}]}]},{"description":"Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day ","code_information":[{"code":"95992","type":"CPT"}],"standard_charges":[{"modifiers":"GP|CQ","modifiers_description":"Services delivered under an outpatient physical therapy plan of care|Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant","setting":"outpatient","minimum":35.50,"maximum":42.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":36.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":36.21,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":39.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.50,"methodology":"fee schedule"}]}]},{"description":"Carbidopa levodopa ent 10 ","code_information":[{"code":"9320","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":235.06,"maximum":282.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":240.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":251.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":249.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":239.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":239.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":258.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":251.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":258.57,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":239.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":251.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":235.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":235.06,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":282.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":235.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":258.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":270.32,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":236.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":235.06,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":246.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":235.06,"methodology":"fee schedule"}]}]},{"description":"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC ","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":42242.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4124.10,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4224.68,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4264.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19058.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24214.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19058.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4063.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4063.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27466.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":42242.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27466.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19058.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4425.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":18981.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":7858.27,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":18981.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4264.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":6491.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4103.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4224.68,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4305.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3902.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4224.68,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":4264.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5029.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2870.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4425.86,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":4224.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":4445.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4103.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3830.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4023.51,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4445.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3943.04,"methodology":"fee schedule"}]}]},{"description":"CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC ","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":199965.51,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":35331.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":36192.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36537.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":124680.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":114482.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":87858.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":111652.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":87858.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34813.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34813.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":118713.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":122571.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":118713.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":87858.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37916.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":199965.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":82785.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":199965.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36537.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":68387.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":35158.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":36192.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36882.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33435.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36192.77,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":36537.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":43086.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":30239.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":37916.23,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":36192.77,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":38088.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":35158.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":97250.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":32814.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34469.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38088.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33779.91,"methodology":"fee schedule"}]}]},{"description":"CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC ","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":146434.48,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":26100.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26737.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26991.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":47953.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":44029.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14393.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18287.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14393.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25718.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25718.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":20743.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":31902.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20743.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14393.11,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":28010.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":146434.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":60624.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":146434.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26991.97,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":50079.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25973.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26737.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27246.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24700.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26737.33,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":26991.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":31830.15,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22144.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":28010.53,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":26737.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":28137.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25973.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":68638.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24241.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":25464.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28137.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24954.84,"methodology":"fee schedule"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETER ","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173965.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":112078.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":34887.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":112078.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":91338.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":35737.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":36078.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":124680.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":114482.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":70240.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":89243.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":70240.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":34376.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":34376.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":101230.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":155687.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":101230.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":70240.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":37439.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173965.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72025.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173965.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":36078.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":67506.81,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":34716.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":35737.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36418.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":33015.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":35737.99,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":36078.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42545.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29849.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":37439.80,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":35737.99,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":37609.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34716.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":82905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":32402.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":34036.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37609.98,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":33355.46,"methodology":"fee schedule"}]}]},{"description":"Cardiovascular disease , IL-16, FAS, FASLigand, HGF, CTACK, EOTAXIN, and MCP-3 by immunoassay combined with age, sex, family history, and personal history of diabetes, blood, algorithm reported as a 5 ","code_information":[{"code":"0415U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":371.21,"maximum":468.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":400.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":414.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":398.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":418.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":468.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":371.21,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":429.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":449.36,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":392.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":390.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":410.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":390.75,"methodology":"fee schedule"}]}]},{"description":"CAROTID ARTERY STENT PROCEDURES WITH MCC ","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":90462.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":46874.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29670.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":46874.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":38200.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30394.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30684.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19772.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25122.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19772.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29236.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29236.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28496.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":43826.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28496.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19772.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31841.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":90462.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37453.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":90462.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30684.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":57160.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29526.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30394.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30973.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28078.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":30394.54,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":30684.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36183.97,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25275.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":31841.90,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":30394.54,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":31986.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":29526.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":69189.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27557.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28947.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31986.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28368.24,"methodology":"fee schedule"}]}]},{"description":"Catheterization for collection of specimen(s) (multiple patients) ","code_information":[{"code":"P9615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8.39,"maximum":10.60,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.83,"methodology":"fee schedule"}]}]},{"description":"Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count ","code_information":[{"code":"89051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.07,"maximum":6.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.74,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.16,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.60,"methodology":"fee schedule"}]}]},{"description":"Certolizumab pegol inj 1m ","code_information":[{"code":"1474","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4.65,"maximum":5.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.65,"methodology":"fee schedule"}]}]},{"description":"CESAREAN SECTION WITHOUT STERILIZATION WITH CC ","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47319.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8720.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":19009.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":15492.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8933.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9018.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":21630.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":19860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21141.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26866.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21141.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8593.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8593.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28563.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26565.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28563.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21141.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9358.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19591.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9018.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11908.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8678.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8933.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9103.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8252.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8933.42,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":11580.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9018.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10635.02,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10270.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9358.82,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8933.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9401.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9322.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8678.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8099.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8508.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9401.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8337.86,"methodology":"fee schedule"}]}]},{"description":"CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; known familial variants ","code_information":[{"code":"81221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":88.11,"maximum":116.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":99.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":104.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":103.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":99.16,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":99.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":106.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":104.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":106.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":99.16,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":104.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":97.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":97.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":88.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":116.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":97.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":92.36,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":106.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":111.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":97.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":97.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":102.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":97.22,"methodology":"fee schedule"}]}]},{"description":"CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC ","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":35198.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6920.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7089.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7156.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4747.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":6031.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4747.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6819.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6819.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6841.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":10521.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6841.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4747.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7426.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":35198.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":14572.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":35198.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7156.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12037.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6886.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7089.25,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7224.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6549.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7089.25,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7156.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8439.59,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5322.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7426.84,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7089.25,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7460.60,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6886.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6427.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6751.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7460.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6616.64,"methodology":"fee schedule"}]}]},{"description":"Chloride; other source ","code_information":[{"code":"82438","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.53,"maximum":6.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.00,"methodology":"fee schedule"}]}]},{"description":"CHOLECYSTECTOMY WITH C.D.E. WITH CC ","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":91618.26,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16648.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17054.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17217.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":25180.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":31993.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":25180.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16405.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16405.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":36290.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":55812.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":36290.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":25180.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17867.03,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":91618.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37930.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":91618.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17217.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31333.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16567.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17054.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17379.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15755.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17054.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17217.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20303.44,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13854.75,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17867.03,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17054.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17948.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16567.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15463.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16242.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17948.24,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15917.90,"methodology":"fee schedule"}]}]},{"description":"Chorionic gonadotropin stimulation panel; testosterone response This panel must include the following: Testosterone (84403 x 2 on 3 pooled blood samples) ","code_information":[{"code":"80414","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":46.80,"maximum":61.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":54.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":52.67,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":52.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":56.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":56.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":52.67,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":55.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":51.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":51.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":46.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":51.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":49.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":56.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":59.39,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":51.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":54.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":51.64,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis; additional cells counted, each study ","code_information":[{"code":"88285","type":"CPT"},{"code":"L000419401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.39,"maximum":32.29,"gross_charge":140.00,"discounted_cash":140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.91,"methodology":"fee schedule"}]}]},{"description":"CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC ","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":36926.70,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7218.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7394.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7464.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11932.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15160.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11932.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7112.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7112.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17196.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26447.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17196.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11932.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7746.58,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":36926.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":15287.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":36926.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7464.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12628.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7183.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7394.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7535.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6831.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7394.46,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7464.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8802.93,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5584.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7746.58,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7394.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7781.79,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7183.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6704.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7042.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7781.79,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6901.50,"methodology":"fee schedule"}]}]},{"description":"CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC ","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":45978.92,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8779.27,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8993.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9079.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12925.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16423.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12925.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8650.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8650.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":18629.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":28650.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":18629.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12925.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9421.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":45978.92,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19035.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":45978.92,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9079.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15724.59,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8736.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8993.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9164.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8308.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8993.40,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9079.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10706.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6953.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9421.66,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8993.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9464.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8736.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8154.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8565.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9464.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8393.84,"methodology":"fee schedule"}]}]},{"description":"Clot retraction ","code_information":[{"code":"85170","type":"CPT"},{"code":"L000201001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.77,"maximum":19.56,"gross_charge":103.25,"discounted_cash":103.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.56,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.30,"methodology":"fee schedule"}]}]},{"description":"Clotting; factor IX (PTC or Christmas) ","code_information":[{"code":"85250","type":"CPT"},{"code":"L000202101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.26,"maximum":22.85,"gross_charge":39.75,"discounted_cash":39.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.42,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.26,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19.04,"methodology":"fee schedule"}]}]},{"description":"Elevating leg rests, pair (for use with capped rental wheelchair base) ","code_information":[{"code":"K0195","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":17.97,"maximum":22.24,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.97,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.53,"methodology":"fee schedule"}]}]},{"description":"ENDOCRINE DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":33483.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6624.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6786.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6850.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7625.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9689.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7625.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6527.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6527.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10990.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16902.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10990.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7625.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7109.48,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":33483.76,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":13862.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":33483.76,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6850.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":11451.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6592.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6786.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6915.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6269.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6786.32,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6850.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8078.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5063.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7109.48,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6786.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7141.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6592.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6152.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6463.16,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7141.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6333.90,"methodology":"fee schedule"}]}]},{"description":"EPISTAXIS WITH MCC ","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":59406.80,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11094.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11365.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11473.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4591.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":5834.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4591.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10932.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10932.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6617.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":10178.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6617.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4591.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11906.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":59406.80,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24594.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":59406.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11473.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":20316.87,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11040.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11365.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11581.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10499.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11365.23,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11473.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13530.04,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8983.65,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11906.43,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11365.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11960.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11040.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10304.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10824.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11960.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10607.55,"methodology":"fee schedule"}]}]},{"description":"Erythropoietin ","code_information":[{"code":"82668","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.03,"maximum":22.55,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.26,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20.11,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20.11,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20.11,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.79,"methodology":"fee schedule"}]}]},{"description":"Estrone ","code_information":[{"code":"82679","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.61,"maximum":29.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":25.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":26.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":22.61,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":23.70,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":27.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":25.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":26.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.95,"methodology":"fee schedule"}]}]},{"description":"Euglobulin lysis ","code_information":[{"code":"85360","type":"CPT"},{"code":"L000205501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.62,"maximum":10.09,"gross_charge":563.25,"discounted_cash":563.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.99,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.25,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.41,"methodology":"fee schedule"}]}]},{"description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) ","code_information":[{"code":"92523","type":"CPT"},{"code":"T000026701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":216.75,"maximum":268.14,"gross_charge":1890.00,"discounted_cash":1890.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":229.04,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":17.40,"standard_charge_algorithm":"Reimbursement will be 17.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":15.20,"standard_charge_algorithm":"Reimbursement will be 15.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":239.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":236.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":227.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":227.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":245.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":239.09,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":245.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":227.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":239.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":223.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":223.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":216.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":268.14,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":223.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":245.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":256.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":224.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":223.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":234.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":223.45,"methodology":"fee schedule"}]}]},{"description":"EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT ","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":185974.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":32918.58,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":33721.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34042.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19807.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25166.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19807.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":32436.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":32436.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28546.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":43902.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28546.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19807.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":35327.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":185974.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":76993.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":185974.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":34042.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":63602.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":32758.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":33721.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":34363.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":31152.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":33721.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":34042.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40144.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":35327.26,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":33721.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":35487.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32758.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30574.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":32115.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":35487.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":31473.38,"methodology":"fee schedule"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":69587.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":39358.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9286.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":39358.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":32075.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9513.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9604.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11909.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15132.11,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11909.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9151.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9151.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17164.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26398.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17164.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11909.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9966.49,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28810.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":69587.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9604.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16731.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9241.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9513.47,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9694.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8788.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9513.47,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9604.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11325.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7398.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9966.49,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9513.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10011.80,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9241.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":19276.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8625.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9060.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10011.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8879.24,"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":570.00,"maximum":720.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":615.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":636.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":642.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":570.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":660.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":603.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"}]}]},{"description":"Factor ix idelvion inj ","code_information":[{"code":"9171","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5.05,"maximum":6.06,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.05,"methodology":"fee schedule"}]}]},{"description":"Factor viii fc fusion rec ","code_information":[{"code":"1656","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.34,"maximum":2.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.34,"methodology":"fee schedule"}]}]},{"description":"FANCC (Fanconi anemia, complementation group C) (eg, Fanconi anemia, type C) gene analysis, common variant (eg, IVS4+4A>T) ","code_information":[{"code":"81242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.79,"maximum":43.94,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":37.54,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":37.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":37.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":43.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":34.79,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":40.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":42.11,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":36.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36.62,"methodology":"fee schedule"}]}]},{"description":"FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES ","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":58551.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":22190.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10947.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":22190.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":18083.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11214.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11320.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9385.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11924.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9385.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10786.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10786.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13526.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20803.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13526.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9385.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11748.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":58551.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24240.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":58551.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11320.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":20024.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10893.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11214.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11427.75,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10359.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11214.15,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11320.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13350.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8854.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11748.15,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11214.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11801.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10893.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":18318.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10167.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10680.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11801.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10466.54,"methodology":"fee schedule"}]}]},{"description":"Fetal aneuploidy short tandem-repeat comparative analysis, fetal DNA from products of conception, reported as normal, monosomy, trisomy, or partial deletion/duplications, mosaicism, and segmental ane ","code_information":[{"code":"0252U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":721.10,"maximum":910.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":778.03,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":804.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":812.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":910.86,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":721.10,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":834.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":872.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":762.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":797.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":759.05,"methodology":"fee schedule"}]}]},{"description":"Fetal fibronectin, cervicovaginal secretions, semi-quantitative ","code_information":[{"code":"82731","type":"CPT"},{"code":"L000114201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":58.37,"maximum":77.29,"gross_charge":1748.75,"discounted_cash":1748.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":66.02,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":68.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":68.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":58.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":77.29,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":61.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":70.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":74.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":64.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"}]}]},{"description":"Fibrin degradation products, D-dimer; qualitative or semiquantitative ","code_information":[{"code":"85378","type":"CPT"},{"code":"L000205901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.81,"maximum":11.66,"gross_charge":206.50,"discounted_cash":206.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.96,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.18,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.72,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.72,"methodology":"fee schedule"}]}]},{"description":"Fibrinolysins or coagulopathy screen, interpretation and report ","code_information":[{"code":"85390","type":"CPT"},{"code":"L000206501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.03,"maximum":18.58,"gross_charge":133.50,"discounted_cash":133.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.03,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.48,"methodology":"fee schedule"}]}]},{"description":"Filter, non disposable, used with positive airway pressure device ","code_information":[{"code":"A7039","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":11.30,"maximum":13.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.65,"methodology":"fee schedule"}]}]},{"description":"Flortaucipir inj 1 millic ","code_information":[{"code":"709","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3710.00,"maximum":4452.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3802.75,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3969.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3932.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3784.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3784.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4081.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3969.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4081.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3784.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3969.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3710.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3710.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":4452.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3710.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4081.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4266.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3728.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3710.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3895.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3710.00,"methodology":"fee schedule"}]}]},{"description":"Fluocinolone acetonide im ","code_information":[{"code":"9225","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":333.48,"maximum":400.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":341.82,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":356.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":353.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":340.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":340.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":366.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":356.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":366.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":340.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":356.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":400.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":366.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":383.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":335.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":333.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":350.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":333.48,"methodology":"fee schedule"}]}]},{"description":"Folic acid; serum ","code_information":[{"code":"82746","type":"CPT"},{"code":"L000114401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.33,"maximum":17.64,"gross_charge":163.00,"discounted_cash":163.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.07,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.70,"methodology":"fee schedule"}]}]},{"description":"Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric) ","code_information":[{"code":"E0731","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":288.53,"maximum":356.94,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":304.89,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":318.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":315.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":303.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":303.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":327.19,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":318.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":327.19,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":303.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":318.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":297.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":297.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":288.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":356.94,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":297.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":327.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":342.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":298.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":297.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":312.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":297.45,"methodology":"fee schedule"}]}]},{"description":"FRACTURES OF HIP AND PELVIS WITH MCC ","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":57163.09,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10707.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10968.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11073.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11869.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15081.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11869.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10551.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10551.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17107.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":26309.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17107.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11869.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11491.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":57163.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23665.57,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":57163.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11073.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19549.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10655.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10968.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11177.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10133.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10968.91,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11073.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13058.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8644.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11491.24,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10968.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11543.47,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10655.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9945.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10446.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11543.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10237.65,"methodology":"fee schedule"}]}]},{"description":"FULL TERM NEONATE WITH MAJOR PROBLEMS ","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":38733.71,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":6208.00,"methodology":"per diem"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31761.64,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":6208.00,"methodology":"per diem"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32536.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32846.19,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5663.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7195.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5663.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":31296.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":31296.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8162.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":12553.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8162.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5663.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":34085.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32846.19,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":31606.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32536.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":33156.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30057.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32536.32,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":32846.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":38733.71,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":34085.67,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":32536.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":34240.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31606.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4478.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":29499.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30986.97,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":34240.60,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30367.23,"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":261.09,"maximum":329.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":281.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":261.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"}]}]},{"description":"Galactose-1-phosphate uridyl transferase; quantitative ","code_information":[{"code":"82775","type":"CPT"},{"code":"L000115001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":19.10,"maximum":25.28,"gross_charge":577.25,"discounted_cash":577.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":19.10,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":25.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":20.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":23.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":24.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21.07,"methodology":"fee schedule"}]}]},{"description":"Gammagard liquid injectio ","code_information":[{"code":"944","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":49.69,"maximum":59.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50.93,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":52.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":50.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":53.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":54.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":57.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":49.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":52.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":49.69,"methodology":"fee schedule"}]}]},{"description":"Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry ","code_information":[{"code":"82810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.86,"maximum":11.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.28,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.77,"methodology":"fee schedule"}]}]},{"description":"Gastroenterology (irritable bowel syndrome [IBS]), immunoassay for anti-CdtB and anti-vinculin antibodies, utilizing plasma, algorithm for elevated or not elevated qualitative results ","code_information":[{"code":"0164U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":106.42,"maximum":134.42,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":114.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":119.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":118.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":114.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":114.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":123.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":119.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":123.22,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":114.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":119.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":134.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":106.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":123.22,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":128.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":112.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":112.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":117.62,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":112.02,"methodology":"fee schedule"}]}]},{"description":"Gel or gel-like pressure pad for mattress, standard mattress length and width ","code_information":[{"code":"E0185","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":302.92,"maximum":374.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":320.10,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":334.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":331.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":318.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":318.54,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":343.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":334.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":343.52,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":318.54,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":334.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":312.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":312.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":302.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":374.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":312.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":343.52,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":359.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":313.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":312.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":327.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":312.29,"methodology":"fee schedule"}]}]},{"description":"General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware ","code_information":[{"code":"E2611","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":274.23,"maximum":339.25,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":289.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":302.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":299.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":310.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":302.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":310.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":288.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":302.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":282.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":282.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":274.23,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":339.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":282.71,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":310.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":325.12,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":284.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":282.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":296.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":282.71,"methodology":"fee schedule"}]}]},{"description":"Gentamicin ","code_information":[{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.85,"maximum":19.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.38,"methodology":"fee schedule"}]}]},{"description":"Glucagon hydrochloride ","code_information":[{"code":"9042","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":192.30,"maximum":230.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":197.11,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":205.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":203.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":196.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":196.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":211.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":205.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":211.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":196.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":205.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":192.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":192.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":230.76,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":192.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":211.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":221.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":193.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":192.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":201.92,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":192.30,"methodology":"fee schedule"}]}]},{"description":"Glucose; blood, reagent strip ","code_information":[{"code":"82948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.57,"maximum":6.05,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.04,"methodology":"fee schedule"}]}]},{"description":"Glutathione ","code_information":[{"code":"82978","type":"CPT"},{"code":"L000119902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.01,"maximum":18.54,"gross_charge":64.75,"discounted_cash":64.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.77,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16.22,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.45,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin, chorionic (hCG); quantitative ","code_information":[{"code":"84702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.64,"maximum":18.06,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.43,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":13.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":18.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14.30,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"}]}]},{"description":"Growth hormone, human (HGH) (somatotropin) ","code_information":[{"code":"83003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.11,"maximum":20.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.67,"methodology":"fee schedule"}]}]},{"description":"Haptoglobin; phenotypes ","code_information":[{"code":"83012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.38,"maximum":32.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.56,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.89,"methodology":"fee schedule"}]}]},{"description":"HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); full gene sequence ","code_information":[{"code":"81364","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":308.35,"maximum":389.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":332.69,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":347.30,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":344.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":331.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":331.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":357.04,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":347.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":357.04,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":331.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":347.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":389.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":308.35,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":357.04,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":373.27,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":326.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":324.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":340.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":324.58,"methodology":"fee schedule"}]}]},{"description":"HEART FAILURE AND SHOCK WITH MCC ","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":56088.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":28554.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10522.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":28554.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":23269.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10779.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10881.76,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":24718.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":22697.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11189.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14216.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11189.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10368.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10368.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16126.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24801.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16126.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11189.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11292.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":56088.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":23220.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":56088.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10881.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19182.03,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10471.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10779.10,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10984.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9957.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10779.10,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10881.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12832.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8481.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11292.39,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10779.10,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11343.72,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10471.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":28435.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9773.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10265.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11343.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10060.49,"methodology":"fee schedule"}]}]},{"description":"Heinz bodies; direct ","code_information":[{"code":"85441","type":"CPT"},{"code":"L000207701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.80,"maximum":5.04,"gross_charge":121.25,"discounted_cash":121.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.30,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":3.99,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4.20,"methodology":"fee schedule"}]}]},{"description":"Hematology (autosomal dominant congenital thrombocytopenia), genomic sequence analysis of 14 genes, blood, buccal swab, or amniotic fluid ","code_information":[{"code":"0269U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":577.76,"maximum":729.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":623.37,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":644.66,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":650.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":729.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":577.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":668.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":699.40,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":611.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":638.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"}]}]},{"description":"Hematology (heparin-induced thrombocytopenia), platelet antibody reactivity by flow cytometry, serum ","code_information":[{"code":"0275U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.45,"maximum":22.04,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.04,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.13,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.37,"methodology":"fee schedule"}]}]},{"description":"Hematolymphoid neoplasm or disorder, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mRNA express ","code_information":[{"code":"81450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":721.55,"maximum":911.44,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":778.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":812.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":774.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":774.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":835.48,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":812.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":835.48,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":774.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":812.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":911.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":721.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":835.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":873.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":759.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":797.51,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":759.53,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin ","code_information":[{"code":"88740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.50,"maximum":11.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9.60,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":8.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.90,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9.37,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; methemoglobin, qualitative ","code_information":[{"code":"83045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.88,"maximum":7.79,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.79,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.49,"methodology":"fee schedule"}]}]},{"description":"Hemolysins and agglutinins; auto, screen, each ","code_information":[{"code":"86940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.94,"maximum":10.52,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.99,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.52,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.33,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.65,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.77,"methodology":"fee schedule"}]}]},{"description":"Heparin-protamine tolerance test ","code_information":[{"code":"85530","type":"CPT"},{"code":"L000208701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.86,"maximum":15.71,"gross_charge":263.00,"discounted_cash":263.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.42,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"Hepatitis Be antibody (HBeAb) ","code_information":[{"code":"86707","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.49,"maximum":13.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.57,"methodology":"fee schedule"}]}]},{"description":"Hepcidin-25, enzyme-linked immunosorbent assay (ELISA), serum or plasma ","code_information":[{"code":"0251U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.41,"maximum":20.72,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":18.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20.72,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":17.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"}]}]},{"description":"Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), genomic sequence analysis panel utilizing a combination A of NGS, San ","code_information":[{"code":"0101U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1656.75,"maximum":2092.74,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1787.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1866.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1848.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1778.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1778.83,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1918.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1866.03,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1918.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1778.83,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1866.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1743.95,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1743.95,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2092.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1743.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1656.75,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1918.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2005.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1752.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1743.95,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1831.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1743.95,"methodology":"fee schedule"}]}]},{"description":"Hereditary ovarian cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted mRNA sequence analysis panel (17 genes) (List separately ","code_information":[{"code":"0132U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":704.56,"maximum":889.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":760.18,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":793.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":786.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":756.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":756.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":815.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":793.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":815.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":756.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":793.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":741.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":741.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":889.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":741.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":704.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":815.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":852.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":745.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":741.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":778.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":741.64,"methodology":"fee schedule"}]}]},{"description":"Heterophile antibodies; screening ","code_information":[{"code":"86308","type":"CPT"},{"code":"L000252901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.69,"maximum":6.22,"gross_charge":66.50,"discounted_cash":66.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.31,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.22,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.18,"methodology":"fee schedule"}]}]},{"description":"HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC ","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":83504.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":38635.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22648.44,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":38635.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":31485.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23200.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23421.80,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":46348.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":42555.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":22513.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":28604.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":22513.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22317.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22317.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":32446.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":49900.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":32446.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":22513.27,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24305.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":83504.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":34572.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":83504.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23421.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 7+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":43232.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22537.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23200.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23642.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":21433.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":23200.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":23421.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27620.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19116.50,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24305.64,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":23200.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":24416.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":22537.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":56913.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":21035.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22096.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24416.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":21654.12,"methodology":"fee schedule"}]}]},{"description":"Hiv prep, inj, cabotegrav ","code_information":[{"code":"805","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":6.81,"maximum":8.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.83,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.81,"methodology":"fee schedule"}]}]},{"description":"HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA-A, -B, -C, and -DRB1 ","code_information":[{"code":"81378","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":313.21,"maximum":414.68,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":354.21,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":369.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":366.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":352.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":352.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":380.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":369.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":380.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":352.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":369.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":313.21,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":414.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":328.29,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":380.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":397.41,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":347.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":345.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":362.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":345.57,"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":115.50,"maximum":152.92,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":130.62,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":136.35,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":135.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":129.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":129.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":140.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":136.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":140.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":129.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":136.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":115.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":152.92,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":121.06,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":140.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":128.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":133.80,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":127.43,"methodology":"fee schedule"}]}]},{"description":"HLA typing; DR/DQ, multiple antigens ","code_information":[{"code":"86817","type":"CPT"},{"code":"L000323401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":96.20,"maximum":127.37,"gross_charge":1748.75,"discounted_cash":1748.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":108.79,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":112.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":108.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":113.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":106.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":106.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":96.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":127.37,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":106.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":100.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":116.75,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":122.06,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":106.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":111.45,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":106.14,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, without mattress ","code_information":[{"code":"E0302","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":702.79,"maximum":869.44,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":742.64,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":775.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":768.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":739.02,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":739.02,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":796.98,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":775.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":796.98,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":739.02,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":775.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":724.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":724.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":702.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":869.44,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":724.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":796.98,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":833.21,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":728.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":724.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":760.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":724.53,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress ","code_information":[{"code":"E0261","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":104.75,"maximum":129.59,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":110.69,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":115.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":114.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":118.79,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":115.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":118.79,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":110.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":115.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":107.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":107.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":104.75,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":129.59,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":107.99,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":118.79,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":124.19,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":108.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":107.99,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":113.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":107.99,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, variable height, hi-lo, with any type side rails, without mattress ","code_information":[{"code":"E0256","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":82.24,"maximum":101.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":86.90,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":90.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":89.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":86.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":86.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":93.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":90.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":93.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":86.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":90.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":84.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":84.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":82.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":101.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":84.78,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":93.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":97.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":85.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":84.78,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":89.02,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":84.78,"methodology":"fee schedule"}]}]},{"description":"Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution ","code_information":[{"code":"86825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99.24,"maximum":131.39,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":112.23,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":117.15,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":116.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":111.68,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":111.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":120.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":117.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":120.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":111.68,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":117.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":99.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":131.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":104.02,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":120.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":125.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":110.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":109.49,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":114.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":109.49,"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":116.11,"maximum":146.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":125.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":129.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":130.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":146.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":116.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":134.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":140.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":122.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":128.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"}]}]},{"description":"Hydroxyprogesterone, 17-d ","code_information":[{"code":"83498","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.63,"maximum":32.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":24.63,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":27.17,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":27.17,"methodology":"fee schedule"}]}]},{"description":"HYPERTENSIVE ENCEPHALOPATHY WITH MCC ","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":66460.31,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12310.85,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12611.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12731.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7852.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9976.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7852.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12130.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12130.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11316.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17403.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11316.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7852.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13211.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":66460.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":27514.63,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":66460.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12731.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22729.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12250.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12611.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12851.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11650.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12611.12,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12731.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15013.24,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10050.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13211.65,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12611.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13271.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12250.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11434.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12010.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13271.70,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11770.38,"methodology":"fee schedule"}]}]},{"description":"IDH1 (isocitrate dehydrogenase 1 ºNADP+», soluble) (eg, glioma), common variants (eg, R132H, R132C) ","code_information":[{"code":"81120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":183.59,"maximum":231.90,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":198.08,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":204.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":197.12,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":206.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":231.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":183.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":212.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":194.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":193.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":202.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":193.25,"methodology":"fee schedule"}]}]},{"description":"IGK@ (Immunoglobulin kappa light chain locus) (eg, leukemia and lymphoma, B-cell), gene rearrangement analysis, evaluation to detect abnormal clonal population(s) ","code_information":[{"code":"81264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":164.09,"maximum":207.28,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":177.05,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":184.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":183.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":176.18,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":176.18,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":190.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":184.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":190.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":176.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":184.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":207.28,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":164.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":190.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":198.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":173.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":172.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":181.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":172.73,"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":16.67,"maximum":22.08,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":22.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":21.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29) ","code_information":[{"code":"86300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.86,"maximum":24.97,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":21.33,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":22.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":21.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":22.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":18.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24.97,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":20.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20.81,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20.81,"methodology":"fee schedule"}]}]},{"description":"Immunofixation electrophoresis; serum ","code_information":[{"code":"86334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.24,"maximum":26.81,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.90,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":20.24,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21.22,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.69,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.34,"methodology":"fee schedule"}]}]},{"description":"Inf dis, pathogen spec DNA/RNA, 21 targets, SARS-CoV-2, ampol probe tec, incl multplx rev tx to RNA targ, ea analyte rep as det or not det ","code_information":[{"code":"0240U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129.27,"maximum":171.16,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":146.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":152.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":151.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":156.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":152.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":156.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":152.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":129.27,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":171.16,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":135.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":156.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":164.02,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":143.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":149.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":142.63,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening ","code_information":[{"code":"G0435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":14.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"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":"87332","type":"CPT"},{"code":"L000360101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":14.38,"gross_charge":329.25,"discounted_cash":329.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"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"}],"standard_charges":[{"setting":"outpatient","minimum":10.45,"maximum":13.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.26,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.53,"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":"87425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.85,"maximum":14.38,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12.28,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":14.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Chlamydia trachomatis ","code_information":[{"code":"87810","type":"CPT"},{"code":"L000386401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":31.98,"maximum":42.35,"gross_charge":329.25,"discounted_cash":329.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":36.17,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":36.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":36.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":36.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":31.98,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":42.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":33.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":38.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":40.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":35.29,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35.29,"methodology":"fee schedule"}]}]},{"description":"Inj, cimerli, 0.1 mg ","code_information":[{"code":"9117","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":201.01,"maximum":241.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":206.04,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":215.08,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":213.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":205.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":205.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":221.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":215.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":221.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":205.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":215.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":201.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":201.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":241.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":201.01,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":221.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":231.16,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":202.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":201.01,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":211.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":201.01,"methodology":"fee schedule"}]}]},{"description":"Inj, denosumab ","code_information":[{"code":"9272","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":26.96,"maximum":32.35,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":27.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":27.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":27.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":27.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":28.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":32.35,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":29.66,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":31.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":27.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":26.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":28.31,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":26.96,"methodology":"fee schedule"}]}]},{"description":"Inj, etelcalcetide, 0.1 m ","code_information":[{"code":"9031","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.56,"maximum":3.08,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.62,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.69,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.56,"methodology":"fee schedule"}]}]},{"description":"Inj, fylnetra, 0.5 mg ","code_information":[{"code":"9118","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":186.19,"maximum":223.42,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":190.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":199.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":197.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":189.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":189.91,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":204.80,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":199.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":204.80,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":189.91,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":199.22,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":186.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":186.19,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":223.42,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":186.19,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":204.80,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":214.11,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":187.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":186.19,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":195.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":186.19,"methodology":"fee schedule"}]}]},{"description":"Inj, kovaltry, 1 i.u. ","code_information":[{"code":"9075","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.48,"maximum":1.77,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.48,"methodology":"fee schedule"}]}]},{"description":"Inj, linezolid (hospira) ","code_information":[{"code":"9167","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":14.76,"maximum":17.71,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":15.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":14.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":15.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14.76,"methodology":"fee schedule"}]}]},{"description":"Inj, nitroglycerin, 5 mg ","code_information":[{"code":"9404","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.41,"maximum":1.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.62,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.48,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.41,"methodology":"fee schedule"}]}]},{"description":"Inj, pedmark, 100 mg ","code_information":[{"code":"9119","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":96.08,"maximum":115.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":98.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":101.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":98.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":98.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":105.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":105.69,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":98.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":102.81,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":96.08,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":96.08,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":115.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":96.08,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":105.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":110.49,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":96.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":96.08,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":100.88,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":96.08,"methodology":"fee schedule"}]}]},{"description":"Inj, rezafungin, 1 mg ","code_information":[{"code":"9267","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":10.12,"maximum":12.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.37,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.12,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10.63,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.12,"methodology":"fee schedule"}]}]},{"description":"Inj, taliglucerase alfa 1 ","code_information":[{"code":"9294","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":42.58,"maximum":51.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":45.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":45.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":42.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":42.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":42.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":46.84,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":48.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":42.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":44.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":42.58,"methodology":"fee schedule"}]}]},{"description":"Inj, tyenne, 1 mg ","code_information":[{"code":"784","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5.04,"maximum":6.05,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.17,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.04,"methodology":"fee schedule"}]}]},{"description":"Inj, vutrisiran, 1 mg ","code_information":[{"code":"9009","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4926.00,"maximum":5911.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5049.15,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":5270.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5221.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5024.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5024.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":5418.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":5270.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5418.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5024.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5270.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4926.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4926.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5911.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4926.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":5418.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5664.90,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4950.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4926.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":5172.30,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4926.00,"methodology":"fee schedule"}]}]},{"description":"Inj. cefepime hcl (baxter ","code_information":[{"code":"9162","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":5.83,"maximum":7.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.71,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.83,"methodology":"fee schedule"}]}]},{"description":"Inj. jivi 1 iu ","code_information":[{"code":"9299","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2.44,"maximum":2.93,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2.44,"methodology":"fee schedule"}]}]},{"description":"Inj. pemetrexed, 10 mg ","code_information":[{"code":"9442","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":50.83,"maximum":61.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":52.10,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":53.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":51.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":54.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":50.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":50.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":61.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":50.83,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":55.91,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":58.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":51.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":50.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":53.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":50.83,"methodology":"fee schedule"}]}]},{"description":"Inj., aprepitant, 1 mg ","code_information":[{"code":"9463","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.76,"maximum":2.12,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.12,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.76,"methodology":"fee schedule"}]}]},{"description":"Inj., emapalumab-lzsg, 1 ","code_information":[{"code":"9310","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":378.03,"maximum":453.63,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":387.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":404.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":400.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":385.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":385.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":415.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":404.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":415.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":385.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":404.49,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":453.63,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":415.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":434.73,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":379.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":378.03,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":396.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":378.03,"methodology":"fee schedule"}]}]},{"description":"Inj., kanjinti, 10 mg ","code_information":[{"code":"9330","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":24.33,"maximum":29.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.94,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":26.04,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":29.20,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.33,"methodology":"fee schedule"}]}]},{"description":"Inj., rituximab, 10 mg ","code_information":[{"code":"9186","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":77.31,"maximum":92.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":79.25,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":82.73,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":81.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":82.73,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":82.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":77.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":77.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":92.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":77.31,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":85.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":88.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":77.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":77.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":81.18,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":77.31,"methodology":"fee schedule"}]}]},{"description":"Injection glatiramer acet ","code_information":[{"code":"1015","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":172.88,"maximum":207.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":177.21,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":184.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":183.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":176.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":176.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":190.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":184.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":190.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":176.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":184.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":172.88,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":172.88,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":207.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":172.88,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":190.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":198.82,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":173.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":172.88,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":181.53,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":172.88,"methodology":"fee schedule"}]}]},{"description":"Injection, bortezomib, 0. ","code_information":[{"code":"9207","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.57,"maximum":1.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.57,"methodology":"fee schedule"}]}]},{"description":"Injection, edaravone, 1 m ","code_information":[{"code":"9493","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":22.14,"maximum":26.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.69,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.58,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.14,"methodology":"fee schedule"}]}]},{"description":"Injection, khapzory, 0.5 ","code_information":[{"code":"9334","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.38,"maximum":1.65,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1.65,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.38,"methodology":"fee schedule"}]}]},{"description":"Injection, peramivir ","code_information":[{"code":"9451","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1.68,"maximum":2.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1.80,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1.80,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1.80,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1.93,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1.68,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1.68,"methodology":"fee schedule"}]}]},{"description":"Injection, udenyca 0.5 mg ","code_information":[{"code":"9195","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":143.38,"maximum":172.05,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":146.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":153.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":151.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":146.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":146.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":157.71,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":153.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":157.71,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":146.24,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":153.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":143.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":143.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":172.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":143.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":157.71,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":164.88,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":144.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":143.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":150.55,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":143.38,"methodology":"fee schedule"}]}]},{"description":"Insulin tolerance panel; for growth hormone deficiency This panel must include the following: Glucose (82947 x 5) Human growth hormone (HGH) (83003 x 5) ","code_information":[{"code":"80435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.35,"maximum":123.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":105.57,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":110.21,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":109.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":105.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":105.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":113.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":110.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":113.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":105.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":110.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":103.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":103.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":93.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":123.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":103.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":97.85,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":113.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":118.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":103.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":103.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":108.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":103.00,"methodology":"fee schedule"}]}]},{"description":"Interferon alfa-2b inj ","code_information":[{"code":"836","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":28.66,"maximum":34.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.38,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30.67,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32.96,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28.66,"methodology":"fee schedule"}]}]},{"description":"INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC ","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":63342.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":27365.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5952.52,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":27365.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":22301.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6097.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6155.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14563.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":18504.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14563.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5865.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5865.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":20989.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":32280.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20989.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14563.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6388.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":48710.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20167.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":48710.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6155.77,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10118.01,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5923.48,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6097.70,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6213.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5633.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6097.70,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6155.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7259.17,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4473.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6388.07,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6097.70,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6417.10,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5923.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5528.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5807.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6417.10,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5691.19,"methodology":"fee schedule"}]}]},{"description":"Iodine I-125 sodium iodid ","code_information":[{"code":"2632","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":60.15,"maximum":72.18,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":61.65,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":64.36,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":63.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":61.35,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":61.35,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":66.17,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":64.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":66.17,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":61.35,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":64.36,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":72.18,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":66.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":69.17,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":60.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":60.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":63.16,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":60.15,"methodology":"fee schedule"}]}]},{"description":"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC A ","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":60378.22,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11262.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11536.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11646.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":24902.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":31639.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":24902.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11097.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11097.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":35889.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":55195.94,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":35889.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":24902.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12086.18,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":60378.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24996.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":60378.22,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11646.69,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":20649.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11207.19,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11536.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11756.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10657.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11536.81,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11646.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13734.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9130.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12086.18,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11536.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12141.12,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11207.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10460.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10987.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12141.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10767.69,"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":175.94,"maximum":222.24,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":189.83,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":196.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":198.16,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":222.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":175.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":203.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":212.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":186.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC ","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":67803.10,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11997.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12289.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12407.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":30590.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":38866.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":30590.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11821.78,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11821.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":44086.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":67803.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44086.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":30590.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12875.20,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":64642.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":26761.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":64642.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12407.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":22107.33,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11938.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12289.97,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12524.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11353.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12289.97,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12407.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14630.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9775.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12875.20,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12289.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12933.73,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11938.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":27805.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11142.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11704.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12933.73,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11470.64,"methodology":"fee schedule"}]}]},{"description":"KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC ","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":31128.29,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6218.59,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6370.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6430.93,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8216.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":10439.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8216.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6127.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6127.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":11841.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18211.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":11841.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8216.56,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6673.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":31128.29,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12887.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":31128.29,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6430.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10645.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6188.26,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6370.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6491.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5884.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6370.26,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6430.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7583.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4707.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6673.61,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6370.26,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6703.94,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6188.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5775.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6066.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6703.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5945.58,"methodology":"fee schedule"}]}]},{"description":"KLF1 (Kruppel-like factor 1), targeted sequencing (ie, exon 13) ","code_information":[{"code":"0195U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":356.49,"maximum":450.30,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":384.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":401.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":397.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":382.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":382.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":412.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":401.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":412.78,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":382.75,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":401.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":450.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":356.49,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":412.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":431.54,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":377.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":394.01,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":375.25,"methodology":"fee schedule"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC ","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":91154.05,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16568.78,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":16972.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17134.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":28433.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":36126.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":28433.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16326.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16326.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":40979.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":63023.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":40979.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":28433.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17781.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":91154.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":37737.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":91154.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17134.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":31174.29,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16487.95,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16972.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":17296.19,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":15679.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16972.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17134.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":20205.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":13784.55,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17781.13,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":16972.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":17861.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":16487.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":39001.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":15388.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16164.66,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17861.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":15841.37,"methodology":"fee schedule"}]}]},{"description":"Lactate (lactic acid) ","code_information":[{"code":"83605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.49,"maximum":13.88,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":10.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.99,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12.73,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11.57,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11.57,"methodology":"fee schedule"}]}]},{"description":"Lamotrigine ","code_information":[{"code":"80175","type":"CPT"},{"code":"L000003901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.01,"maximum":15.90,"gross_charge":374.25,"discounted_cash":374.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13.58,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":12.01,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15.90,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"}]}]},{"description":"Laser Eye Procedures ","code_information":[{"code":"5481","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":535.09,"maximum":642.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":548.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":572.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":567.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":545.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":545.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":588.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":572.54,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":588.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":545.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":572.54,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":535.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":535.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":642.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":535.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":588.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":615.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":537.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":535.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":561.84,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":535.09,"methodology":"fee schedule"}]}]},{"description":"Leukocyte alkaline phosphatase with count ","code_information":[{"code":"85540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.80,"maximum":10.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.60,"methodology":"fee schedule"}]}]},{"description":"Leuprolide inj, camcevi, ","code_information":[{"code":"9050","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":55.00,"maximum":66.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.37,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":58.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":56.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":56.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":60.50,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":60.50,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":56.10,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":58.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":55.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":55.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":66.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":55.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":60.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":63.25,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":55.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":55.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":57.75,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":55.00,"methodology":"fee schedule"}]}]},{"description":"Level 1 Electrophysiologi ","code_information":[{"code":"5211","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1095.58,"maximum":1314.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1122.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1172.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1161.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1117.49,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1117.49,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1205.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1172.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1205.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1117.49,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1172.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1095.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1095.58,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1314.69,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1095.58,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1205.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1259.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1101.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1095.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1150.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1095.58,"methodology":"fee schedule"}]}]},{"description":"Level 1 Imaging with Cont ","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":169.14,"maximum":202.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":173.36,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":180.98,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":179.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":172.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":172.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":186.05,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":180.98,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":186.05,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":172.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":180.98,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":169.14,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":169.14,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":202.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":169.14,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":186.05,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":194.51,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":169.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":169.14,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":177.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":169.14,"methodology":"fee schedule"}]}]},{"description":"Level 1 Nerve Procedures ","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":1777.38,"maximum":2132.85,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1821.81,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1901.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1884.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1812.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1812.92,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1955.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1901.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1955.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1812.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1901.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1777.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1777.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":2132.85,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1777.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1955.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":2043.98,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1786.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1777.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1866.25,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1777.38,"methodology":"fee schedule"}]}]},{"description":"Level 1 Therapeutic Radia ","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":124.91,"maximum":149.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":128.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":132.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":127.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":127.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":137.40,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":137.40,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":127.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":133.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":124.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":124.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":149.89,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":124.91,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":137.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":143.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":124.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":131.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":124.91,"methodology":"fee schedule"}]}]},{"description":"Level 2 Diagnostic Tests ","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":288.94,"maximum":346.73,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":296.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":309.17,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":306.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":294.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":294.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":317.83,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":309.17,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":317.83,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":294.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":309.17,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":288.94,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":288.94,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":346.73,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":288.94,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":317.83,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":332.28,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":290.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":288.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":303.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":288.94,"methodology":"fee schedule"}]}]},{"description":"Level 2 Gynecologic Proce ","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":295.32,"maximum":354.38,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":302.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":315.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":313.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":301.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":301.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":324.85,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":315.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":324.85,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":301.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":315.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":295.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":295.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":354.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":295.32,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":324.85,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":339.61,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":296.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":295.32,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":310.08,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":295.32,"methodology":"fee schedule"}]}]},{"description":"Level 2 Minor Procedures ","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":36.92,"maximum":44.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":37.84,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":39.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":39.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":37.66,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37.66,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":39.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":37.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":44.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":40.61,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":42.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":37.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":36.92,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":38.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":36.92,"methodology":"fee schedule"}]}]},{"description":"Level 2 Radiation Therapy ","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":247.39,"maximum":296.87,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":253.58,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":264.71,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":262.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":252.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":252.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":272.13,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":264.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":272.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":252.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":264.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":247.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":247.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":296.87,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":247.39,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":272.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":284.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":248.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":247.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":259.76,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":247.39,"methodology":"fee schedule"}]}]},{"description":"Level 3 Blood Product Exc ","code_information":[{"code":"5243","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":4260.13,"maximum":5112.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4366.63,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4558.34,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4515.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4345.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4345.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4686.14,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4558.34,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4686.14,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4345.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4558.34,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4260.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4260.13,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5112.15,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4260.13,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4686.14,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":4899.15,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4281.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4260.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4473.13,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4260.13,"methodology":"fee schedule"}]}]},{"description":"Level 3 Excision/ Biopsy/ ","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":2615.73,"maximum":3138.88,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2681.13,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":2798.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2772.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":2668.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":2668.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":2877.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":2798.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":2877.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":2668.05,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2798.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3138.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":2877.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3008.09,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":2628.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":2615.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":2746.52,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":2615.73,"methodology":"fee schedule"}]}]},{"description":"Level 3 Minor Procedures ","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":56.31,"maximum":67.57,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":57.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":60.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":59.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":57.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":57.43,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":61.94,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":60.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":61.94,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":57.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":60.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":67.57,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":61.94,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":64.75,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":56.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":56.31,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":59.12,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":56.31,"methodology":"fee schedule"}]}]},{"description":"Level 3 Skin Procedures ","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":578.15,"maximum":693.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":592.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":618.62,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":612.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":589.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":589.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":635.97,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":618.62,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":635.97,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":589.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":618.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":578.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":578.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":693.78,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":578.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":635.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":664.87,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":581.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":578.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":607.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":578.15,"methodology":"fee schedule"}]}]},{"description":"Level 4 Diagnostic Tests ","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":962.47,"maximum":1154.96,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":986.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1029.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1020.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1058.72,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1029.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1058.72,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":981.72,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1029.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":962.47,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":962.47,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1154.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":962.47,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1058.72,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1106.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":967.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":962.47,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1010.59,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":962.47,"methodology":"fee schedule"}]}]},{"description":"Level 4 Minor Procedures ","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":117.59,"maximum":141.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":120.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":124.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":119.94,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":119.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":129.35,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":129.35,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":119.94,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":125.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":117.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":117.59,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":141.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":117.59,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":129.35,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":135.23,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":118.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":117.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":123.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":117.59,"methodology":"fee schedule"}]}]},{"description":"Level 4 Urology and Relat ","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":3209.18,"maximum":3851.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":3289.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":3433.82,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3401.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":3273.36,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":3273.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":3530.10,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":3433.82,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3530.10,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":3273.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3433.82,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":3209.18,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":3209.18,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":3851.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":3209.18,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":3530.10,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":3690.55,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":3225.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":3209.18,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":3369.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":3209.18,"methodology":"fee schedule"}]}]},{"description":"Level 5 Neurostimulator a ","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":28585.09,"maximum":34302.11,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29299.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30586.05,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30300.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":29156.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":29156.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31443.60,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30586.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31443.60,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":29156.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30586.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28585.09,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28585.09,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34302.11,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28585.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":31443.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32872.85,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28728.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28585.09,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":30014.34,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28585.09,"methodology":"fee schedule"}]}]},{"description":"Level 6 Urology and Relat ","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":8480.38,"maximum":10176.46,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8692.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9074.01,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8989.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8649.99,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8649.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9328.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9074.01,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9328.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8649.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9074.01,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8480.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8480.38,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10176.46,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8480.38,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9328.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9752.44,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8522.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8480.38,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8904.40,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8480.38,"methodology":"fee schedule"}]}]},{"description":"Lipase ","code_information":[{"code":"83690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.25,"maximum":8.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.06,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6.55,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":6.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":6.89,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, direct measurement; LDL cholesterol ","code_information":[{"code":"83721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.52,"maximum":12.60,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.76,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.52,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.60,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.55,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.07,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.50,"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":478.23,"maximum":604.08,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":515.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":538.64,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":533.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":513.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":513.47,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":553.74,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":538.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":553.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":513.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":538.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":604.08,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":478.23,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":553.74,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":578.91,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":505.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":528.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":503.40,"methodology":"fee schedule"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT ","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":49894.67,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9454.46,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9685.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9777.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11253.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14298.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11253.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9316.10,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9316.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16219.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24944.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16219.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11253.86,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10146.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":49894.67,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":20656.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":49894.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9777.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":17063.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9408.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9685.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9869.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8947.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9685.06,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9777.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":11529.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7545.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10146.25,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9685.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10192.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9408.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8781.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9223.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10192.37,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9039.38,"methodology":"fee schedule"}]}]},{"description":"Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes ","code_information":[{"code":"L0641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":72.49,"maximum":89.68,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":76.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":79.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":76.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":76.22,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":82.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":82.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":76.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":72.49,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":89.68,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":82.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":85.94,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":75.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":74.73,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":78.47,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":74.73,"methodology":"fee schedule"}]}]},{"description":"LUNG TRANSPLANT ","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":561697.55,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":97704.14,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":100087.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 20. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":101040.38,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 20. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":105458.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":133991.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":105458.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":96274.32,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":96274.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":151988.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":233749.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":151988.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":105458.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":104853.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":561697.55,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":232543.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":561697.55,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":101040.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 21+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":192098.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":97227.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":100087.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 20. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":101993.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":92461.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":100087.17,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":101040.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":119151.39,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":84941.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":104853.22,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":100087.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":105329.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":97227.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":95321.11,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":105329.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":93414.69,"methodology":"fee schedule"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC ","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":95946.65,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17395.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17819.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17989.14,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":37504.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":47651.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":37504.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17140.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17140.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":54052.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":83129.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":54052.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":37504.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18667.98,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":95946.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":39722.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":95946.65,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17989.14,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":32813.34,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17310.31,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17819.43,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18158.85,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16461.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17819.43,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":17989.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21213.61,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14509.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18667.98,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17819.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18752.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17310.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16156.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16970.89,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18752.83,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16631.47,"methodology":"fee schedule"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC ","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":45209.52,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8646.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":8857.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8941.85,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10084.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12813.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10084.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8520.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8520.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14534.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22352.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14534.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10084.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9279.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":45209.52,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":18716.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":45209.52,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8941.85,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":15461.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8604.43,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8857.50,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9026.21,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8182.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8857.50,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8941.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10544.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6836.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9279.28,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":8857.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9321.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8604.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8030.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8435.71,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9321.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8267.00,"methodology":"fee schedule"}]}]},{"description":"MAJOR CHEST PROCEDURES WITH CC ","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":108179.61,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19504.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19980.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":20170.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":32994.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":41921.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":32994.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":19219.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":19219.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":47552.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":73132.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":47552.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":32994.79,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":20931.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":108179.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":44786.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":108179.61,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":20170.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":36996.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":19409.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19980.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":20360.77,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18457.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19980.20,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":20170.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23785.95,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":16359.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":20931.64,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":19980.20,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":21026.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":19409.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18115.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19028.76,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":21026.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18648.18,"methodology":"fee schedule"}]}]},{"description":"MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":29997.84,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6023.67,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6170.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6229.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":12328.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15664.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12328.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5935.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5935.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":17768.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":27326.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":17768.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":12328.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6464.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":29997.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12419.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29997.84,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6229.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10259.13,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5994.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6170.59,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6288.12,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5700.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6170.59,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6229.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7345.94,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4536.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6464.43,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6170.59,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6493.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5994.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5594.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5876.75,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6493.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5759.22,"methodology":"fee schedule"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND CO ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":53234.45,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10030.33,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10274.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10372.83,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14070.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":17877.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14070.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":9883.55,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":9883.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":20278.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":31187.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20278.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14070.65,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":10764.26,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":53234.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22039.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":53234.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10372.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18205.95,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":9981.40,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10274.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10470.69,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9492.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10274.98,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10372.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12232.11,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8050.25,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":10764.26,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10274.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":10813.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9981.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9315.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":9785.69,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":10813.19,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9589.98,"methodology":"fee schedule"}]}]},{"description":"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":55473.86,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10416.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":10670.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":10772.15,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":13588.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":17265.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":13588.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10264.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10264.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":19584.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":30119.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":19584.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":13588.63,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11178.65,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":55473.86,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":22966.23,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":55473.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":10772.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":18971.82,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10365.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10670.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10873.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":9857.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10670.53,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":10772.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":12703.01,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8388.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11178.65,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":10670.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11229.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10365.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22617.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":9674.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10162.41,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11229.46,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":9959.16,"methodology":"fee schedule"}]}]},{"description":"Malate dehydrogenase ","code_information":[{"code":"83775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.68,"maximum":8.84,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7.55,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7.52,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":6.68,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8.48,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7.37,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC ","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":74309.01,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13664.20,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13997.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14130.79,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9494.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12062.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9494.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13464.24,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13464.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13683.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":21043.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13683.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9494.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14664.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":74309.01,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":30764.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":74309.01,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14130.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":25413.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13597.55,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13997.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":14264.10,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12931.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13997.48,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":14130.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16663.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11237.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14664.02,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13997.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14730.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13597.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12691.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13330.93,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14730.68,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13064.31,"methodology":"fee schedule"}]}]},{"description":"Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes ","code_information":[{"code":"97140","type":"CPT"}],"standard_charges":[{"modifiers":"GO|CO","modifiers_description":"Services delivered under an outpatient occupational therapy plan of care|Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant","setting":"outpatient","minimum":22.42,"maximum":26.91,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":22.98,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":23.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":22.87,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":22.87,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":22.87,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":23.99,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":26.91,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":24.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":23.54,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22.42,"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":47.07,"maximum":58.24,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":49.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":51.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":49.50,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":49.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":53.38,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":53.38,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":49.50,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":51.93,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":48.53,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":48.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":47.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":58.24,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":48.53,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":53.38,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":48.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":50.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":48.53,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches ","code_information":[{"code":"E2204","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":988.84,"maximum":1223.30,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1044.91,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1090.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1080.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":1039.81,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":1039.81,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1121.36,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1090.78,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1121.36,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":1039.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1090.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":1019.42,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":1019.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":988.84,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1223.30,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":1019.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1121.36,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1172.33,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":1024.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":1019.42,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":1070.39,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":1019.42,"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":27.54,"maximum":34.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":29.10,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":30.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":28.96,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":28.96,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":28.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":27.54,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":34.07,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":31.23,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":32.65,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":28.39,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":29.81,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":28.39,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, wheel lock brake extension (handle), each ","code_information":[{"code":"E0961","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":29.36,"maximum":36.32,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":31.03,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":33.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30.88,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":32.39,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":29.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":36.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":33.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":34.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":30.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":31.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":30.27,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC ","code_information":[{"code":"85547","type":"CPT"},{"code":"L000209001","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.80,"maximum":10.32,"gross_charge":237.75,"discounted_cash":237.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.81,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.80,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":10.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8.17,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9.46,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8.60,"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":13.87,"maximum":16.64,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14.15,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":16.64,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":15.95,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":13.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14.56,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":13.87,"methodology":"fee schedule"}]}]},{"description":"Mercury, quantitative ","code_information":[{"code":"83825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.73,"maximum":19.51,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":16.67,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17.40,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":17.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17.40,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":14.73,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":19.51,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15.45,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":17.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":18.70,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":16.26,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":17.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16.26,"methodology":"fee schedule"}]}]},{"description":"Microsatellite instability analysis (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) of markers for mismatch repair deficiency (eg, BAT25, BAT26), includes comparison of neoplastic and ","code_information":[{"code":"81301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":331.13,"maximum":418.27,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":357.27,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":372.96,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":369.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":355.53,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":355.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":383.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":372.96,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":383.42,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":355.53,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":372.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":418.27,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":331.13,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":383.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":400.84,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":350.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":348.56,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":365.99,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":348.56,"methodology":"fee schedule"}]}]},{"description":"MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC ","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":64010.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11888.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":12178.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12294.35,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15578.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19793.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15578.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11714.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11714.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22452.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34530.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22452.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15578.78,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12758.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":64010.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":26500.31,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":64010.28,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":12294.35,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":21891.24,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11830.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12178.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":12410.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":11250.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12178.36,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":12294.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":14498.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9679.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12758.28,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":12178.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12816.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11830.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11041.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":11598.44,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12816.28,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":11366.47,"methodology":"fee schedule"}]}]},{"description":"Mitoxantrone hydrochl ","code_information":[{"code":"864","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":54.65,"maximum":65.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":57.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":58.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":65.58,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":60.12,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":62.85,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":54.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":54.65,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":57.38,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":54.65,"methodology":"fee schedule"}]}]},{"description":"Molecular cytogenetics; chromosomal in situ hybridization, analyze 3-5 cells (eg, for derivatives and markers) ","code_information":[{"code":"88272","type":"CPT"},{"code":"L000418801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":36.89,"maximum":48.84,"gross_charge":194.25,"discounted_cash":194.25,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":41.72,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":43.55,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":43.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":43.55,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":41.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":43.55,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":40.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":40.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":36.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":48.84,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":40.70,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":38.66,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":44.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":46.80,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":40.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":40.70,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":42.74,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":40.70,"methodology":"fee schedule"}]}]},{"description":"Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation ","code_information":[{"code":"81404","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":261.09,"maximum":329.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":281.70,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":291.32,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":294.07,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":329.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":261.09,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":302.31,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":316.05,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":276.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"}]}]},{"description":"Motion fluoroscopic evaluation of swallowing function by cine or video recording ","code_information":[{"code":"92611","type":"CPT"},{"code":"T000040201","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":87.55,"maximum":108.32,"gross_charge":2081.50,"discounted_cash":2081.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":92.53,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":96.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":95.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":92.08,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":92.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":99.30,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":96.59,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":99.30,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":92.08,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":96.59,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":90.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":90.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":87.55,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":108.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":90.27,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":99.30,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":103.81,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":90.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":90.27,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":94.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":90.27,"methodology":"fee schedule"}]}]},{"description":"MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants ","code_information":[{"code":"81297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":202.63,"maximum":255.96,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":218.63,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":228.23,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":226.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":217.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":217.57,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":234.63,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":228.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":234.63,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":217.57,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":228.23,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":213.30,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":213.30,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":255.96,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":213.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":202.63,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":234.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":245.29,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":214.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":213.30,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":223.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":213.30,"methodology":"fee schedule"}]}]},{"description":"Mucin, synovial fluid (Ropes test) ","code_information":[{"code":"83872","type":"CPT"},{"code":"L000169401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.32,"maximum":7.03,"gross_charge":172.75,"discounted_cash":172.75,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6.01,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7.03,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5.86,"methodology":"fee schedule"}]}]},{"description":"MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALL ","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":164661.86,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":42818.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50539.46,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":42818.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":34896.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":51772.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":52265.20,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":63342.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":58161.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":79174.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":100617.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":79174.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":49799.86,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":49799.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":101885.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":164661.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":101885.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":79174.00,"methodology":"case rate"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54237.47,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":31691.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":76544.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":52265.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 8+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":98551.74,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":50292.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":51772.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":52758.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":47827.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":51772.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":52265.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":61633.49,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":43577.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":54237.47,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":51772.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":54484.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":50292.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":145548.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":46940.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49306.79,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":54484.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":48320.65,"methodology":"fee schedule"}]}]},{"description":"Mycophenolate (mycophenolic acid) ","code_information":[{"code":"80180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.36,"maximum":21.66,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18.50,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":18.41,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19.31,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":16.36,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21.66,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":19.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20.76,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18.95,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":18.05,"methodology":"fee schedule"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. ","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":68893.15,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":12730.35,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13040.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13165.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18975.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":24108.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18975.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":12544.05,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":12544.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27347.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":42058.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27347.03,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18975.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":13661.84,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":68893.15,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":28521.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":68893.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13165.04,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":23561.16,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":12668.25,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13040.84,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13289.24,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12047.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13040.84,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13165.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":15524.81,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10418.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":13661.84,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13040.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":13723.93,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12668.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":11823.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12419.85,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":13723.93,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12171.45,"methodology":"fee schedule"}]}]},{"description":"Natalizumab injection ","code_information":[{"code":"9126","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":24.15,"maximum":28.98,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.76,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":26.57,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":26.57,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25.84,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28.98,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":26.57,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.78,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":24.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":24.15,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25.36,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":24.15,"methodology":"fee schedule"}]}]},{"description":"Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing ","code_information":[{"code":"97606","type":"CPT"},{"code":"T000068601","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":49.25,"maximum":59.10,"gross_charge":234.00,"discounted_cash":234.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":50.48,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":52.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":52.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":50.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":52.70,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":59.10,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":54.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":56.64,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":49.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":51.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":49.25,"methodology":"fee schedule"}]}]},{"description":"Nephrology (chronic kidney disease), multiplex electrochemiluminescent immunoassay (ECLIA) of tumor necrosis factor receptor 1A, receptor superfamily 2 (TNFR1, TNFR2), and kidney injury molecule-1 (KI ","code_information":[{"code":"0105U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":902.50,"maximum":1140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":973.75,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1007.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1016.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":1140.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":902.50,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":1045.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":1092.50,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":954.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid tumor),nextgeneration sequencing (NGS) of DNA from formalin-fixed paraffinembedded (FFPE) tissue with comparative sequence analysis from a matched normal specimen (blood or saliva), 68 ","code_information":[{"code":"0473U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4275.00,"maximum":5400.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4612.50,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":4815.00,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4770.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":4590.00,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":4590.00,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":4950.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":4815.00,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4950.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":4590.00,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4815.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":4500.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":4500.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":5400.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":4500.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4275.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":4950.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":5175.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":4522.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":4500.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":4725.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":4500.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (urothelial), mrna, gene expression profiling by real-time quantitative pcr of 5 genes (mdk, hoxa13, cdc2 ºcdk1», igfbp5, and cxcr2), utilizing urine, algorithm incorporates age, sex, smoking ","code_information":[{"code":"0363U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":722.00,"maximum":912.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":779.00,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":805.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":813.20,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":912.00,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":722.00,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":836.00,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":874.00,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":763.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Oncology, response to chemotherapy drugs using motility contrast tomography, fresh or frozen tissue, reported as likelihood of sensitivity or resistance to drugs or drug combinations ","code_information":[{"code":"0083U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":158.98,"maximum":200.82,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":171.53,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":179.06,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":177.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":170.70,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":170.70,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":184.09,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":179.06,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":184.09,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":170.70,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":179.06,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":167.35,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":167.35,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":200.82,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":167.35,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":158.98,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":184.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":192.45,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":168.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":167.35,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":175.72,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":167.35,"methodology":"fee schedule"}]}]},{"description":"Oral interface used with positive airway pressure device, each ","code_information":[{"code":"A7044","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":121.85,"maximum":150.74,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":128.76,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":134.41,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":133.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":128.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":128.13,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":138.18,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":134.41,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":138.18,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":128.13,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":134.41,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":125.62,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":125.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":121.85,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":150.74,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":125.62,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":138.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":144.46,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":126.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":125.62,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":131.90,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":125.62,"methodology":"fee schedule"}]}]},{"description":"Organic acids; total, quantitative, each specimen ","code_information":[{"code":"83918","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.39,"maximum":28.32,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":24.19,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":25.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":24.07,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":24.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":24.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":25.25,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":23.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":23.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":21.39,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":28.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":23.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":22.42,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":27.14,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":23.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23.60,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":24.78,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":23.60,"methodology":"fee schedule"}]}]},{"description":"Orthovisc inj per dose ","code_information":[{"code":"877","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":122.91,"maximum":147.50,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":125.99,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":131.52,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":130.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":125.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":125.37,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":135.20,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":131.52,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":135.20,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":125.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":131.52,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":122.91,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":122.91,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":147.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":122.91,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":135.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":141.35,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":123.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":122.91,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":129.06,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":122.91,"methodology":"fee schedule"}]}]},{"description":"OSTEOMYELITIS WITHOUT CC/MCC ","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":40454.42,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7334.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7513.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7585.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18251.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":23189.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18251.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7227.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7227.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":26304.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":40454.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":26304.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18251.52,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":7871.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":37601.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":15567.07,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":37601.53,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":7585.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":12859.56,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7298.99,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7513.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":7656.78,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":6941.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7513.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":7585.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":8944.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5686.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":7871.46,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7513.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":7907.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7298.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":6812.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7155.87,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":7907.24,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7012.75,"methodology":"fee schedule"}]}]},{"description":"OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC ","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":173955.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":103123.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23872.09,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":103123.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":84040.00,"methodology":"case rate"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":24454.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":24687.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":126682.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":116319.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":52970.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":67301.84,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":52970.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":23522.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":23522.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":76341.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":117408.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":76341.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":52970.50,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":25618.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72021.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":173955.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":24687.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":45659.67,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":23755.64,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24454.33,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":24920.13,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":22591.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":24454.33,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":24687.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":29112.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":20189.65,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":25618.82,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":24454.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":25735.27,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":23755.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":86744.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 10. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":22171.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":23289.84,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":25735.27,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":22824.04,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC ","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":96793.42,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":17541.16,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":17969.00,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":18140.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":30595.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":38873.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":30595.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":17284.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":17284.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":44094.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":67815.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":44094.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":30595.75,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":18824.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":96793.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":40072.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":96793.42,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":18140.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":33102.93,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":17455.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17969.00,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":18311.26,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":16599.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":17969.00,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":18140.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":21391.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14637.35,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":18824.66,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":17969.00,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":18910.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":17455.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":16291.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":17113.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":18910.23,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":16771.06,"methodology":"fee schedule"}]}]},{"description":"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC ","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":40128.93,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":7770.56,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":7960.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8035.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6698.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8510.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6698.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":7656.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":7656.85,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9653.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":14847.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9653.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6698.46,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":8339.14,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":40128.93,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":16613.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40128.93,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":8035.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":13723.92,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":7732.66,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7960.09,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":8111.71,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":7353.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":7960.09,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":8035.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":9476.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6068.40,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":8339.14,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":7960.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8377.05,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":7732.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":7217.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":7581.04,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":8377.05,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":7429.42,"methodology":"fee schedule"}]}]},{"description":"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":60227.78,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11236.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11510.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11619.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19901.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25285.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19901.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":11071.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":11071.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28682.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":44111.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28682.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19901.48,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":12058.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":60227.78,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24934.35,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":60227.78,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11619.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":20597.64,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":11181.37,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11510.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11729.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10633.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11510.24,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11619.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13702.66,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9107.80,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":12058.34,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11510.24,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":12113.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":11181.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10435.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10962.13,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":12113.15,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10742.89,"methodology":"fee schedule"}]}]},{"description":"OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC ","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":174816.16,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":30994.55,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":31750.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":32052.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":30057.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":38189.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":30057.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":30540.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":30540.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":43318.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":66621.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":43318.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":30057.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":33262.45,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":174816.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":72374.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":174816.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":32052.91,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 9+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":59786.37,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":30843.36,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":31750.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":32355.29,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":29331.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":31750.52,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":32052.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":37798.24,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":26436.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":33262.45,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":31750.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":33413.64,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":30843.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":28787.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":30238.59,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":33413.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":29633.82,"methodology":"fee schedule"}]}]},{"description":"OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC ","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":72250.12,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":13309.19,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":13633.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13763.65,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9229.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11726.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9229.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":13114.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":13114.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13301.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20456.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13301.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9229.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":14283.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":72250.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":29911.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":72250.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":13763.65,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":24709.23,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":13244.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13633.81,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":13893.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":12595.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":13633.81,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":13763.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":16230.73,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10925.85,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":14283.04,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":13633.81,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":14347.96,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":13244.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":12361.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":12984.58,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":14347.96,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":12724.89,"methodology":"fee schedule"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC ","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":47315.69,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9009.77,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":9229.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9317.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5932.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7537.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5932.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":8877.92,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":8877.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8550.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":13149.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8550.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5932.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":9669.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":47315.69,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":19588.74,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47315.69,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":9317.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":16181.76,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":8965.82,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9229.52,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":9405.32,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":8526.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":9229.52,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":9317.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10987.52,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7155.20,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":9669.02,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":9229.52,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":9712.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":8965.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":8368.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":8790.02,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":9712.97,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":8614.22,"methodology":"fee schedule"}]}]},{"description":"OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC ","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":116767.62,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20985.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":21497.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21701.87,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20304.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25798.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20304.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20678.19,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20678.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":29263.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":45005.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29263.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20304.82,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":22520.81,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":116767.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":48341.90,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":116767.62,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21701.87,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":39934.02,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20882.93,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":21497.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21906.60,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19859.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":21497.13,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":21701.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":25591.82,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17657.90,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":22520.81,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":21497.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22623.17,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20882.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":19490.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":20473.46,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22623.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":20063.99,"methodology":"fee schedule"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES ","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":81371.12,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":14881.91,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":15244.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":15390.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11585.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":14719.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11585.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":14664.13,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":14664.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16696.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":25678.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16696.64,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11585.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":15970.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":81371.12,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":33687.71,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":81371.12,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":15390.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":27828.57,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":14809.32,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15244.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":15535.27,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":14083.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15244.89,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":15390.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18148.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12305.15,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":15970.83,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":15244.89,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":16043.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":14809.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":13822.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":14518.94,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":16043.43,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14228.56,"methodology":"fee schedule"}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC ","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":121829.93,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":20445.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":20943.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":21143.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":54965.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":69836.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":54965.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":20145.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":20145.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":79215.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":121829.93,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":79215.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":54965.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":21940.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":113634.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":47044.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":113634.16,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":21143.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":38862.39,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":20345.27,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20943.66,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":21342.58,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":19347.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":20943.66,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":21143.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":24932.92,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":17184.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":21940.97,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":20943.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":22040.71,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":20345.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":18988.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":19946.34,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":22040.71,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":19547.41,"methodology":"fee schedule"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":58190.39,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10884.88,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11150.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11256.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20085.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18443.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":18542.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":23559.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":18542.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10725.59,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10725.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":26724.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41100.38,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":26724.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":18542.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11681.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":58190.39,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":24090.87,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":58190.39,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11256.56,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 2+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":19900.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10831.79,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11150.37,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":11362.76,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10300.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9905.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":11150.37,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":11256.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":13274.25,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8799.70,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11681.34,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":11150.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":11734.44,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":10831.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":14608.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10109.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10619.40,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11734.44,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10407.01,"methodology":"fee schedule"}]}]},{"description":"OTITIS MEDIA AND URI WITHOUT MCC ","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1050.00,"maximum":30591.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6125.95,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":6275.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6335.13,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":15449.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIXOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":14185.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7293.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9266.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7293.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":6036.30,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":6036.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":10511.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":16166.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":10511.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7293.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":6574.19,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":30591.00,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"NBN","standard_charge_dollar":12664.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":30591.00,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":6335.13,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"per diem","additional_payer_notes":"Days 3+. "},{"payer_name":"Evolutions","plan_name":"TieredNetwork","standard_charge_dollar":10461.99,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":6096.06,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6275.36,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":6394.89,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":5797.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":6935.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":6275.36,"methodology":"fee schedule"},{"payer_name":"Molina Healthcare ","plan_name":"HIX","standard_charge_dollar":13318.00,"methodology":"case rate","additional_payer_notes":"Days 3+. "},{"payer_name":"Molina Healthcare","plan_name":"MGMCR","standard_charge_dollar":6335.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"Complementary","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":"Primary","standard_charge_percentage":78.00,"standard_charge_algorithm":"Reimbursement will be 78% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":7470.67,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4626.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WC","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":6574.19,"methodology":"fee schedule"},{"payer_name":"Simply","plan_name":"MGMCR","standard_charge_dollar":6275.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":6604.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":10799.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":6096.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11060.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $1063067.00, reimbursement will be $5566 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlan","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":5689.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":43.30,"standard_charge_algorithm":"Reimbursement will be 43.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":5976.53,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":6604.07,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":5857.00,"methodology":"fee schedule"}]}]},{"description":"Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate ","code_information":[{"code":"E1390","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":163.89,"maximum":202.75,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":173.18,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":180.79,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":179.10,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":172.34,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":172.34,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":185.86,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":180.79,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":185.86,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":172.34,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":180.79,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":163.89,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":202.75,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":185.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":194.30,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":169.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":168.96,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":177.41,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":168.96,"methodology":"fee schedule"}]}]},{"description":"PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic cancer) gene analysis; full gene sequence ","code_information":[{"code":"81307","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":642.67,"maximum":811.80,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":693.41,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":723.86,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":717.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":690.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":690.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":744.15,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":723.86,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":744.15,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":690.03,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":723.86,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":811.80,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":642.67,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":744.15,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":777.97,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":679.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":676.50,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":710.33,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":676.50,"methodology":"fee schedule"}]}]},{"description":"Panitumumab injection ","code_information":[{"code":"9235","type":"APC"}],"standard_charges":[{"setting":"outpatient","minimum":159.33,"maximum":191.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":163.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":170.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":168.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":162.51,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":162.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":175.26,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":170.48,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":175.26,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":162.51,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":170.48,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":191.19,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":175.26,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":183.22,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":160.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":159.33,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":167.29,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":159.33,"methodology":"fee schedule"}]}]},{"description":"Particle agglutination; titer, each antibody ","code_information":[{"code":"86406","type":"CPT"},{"code":"L000273801","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":9.64,"maximum":12.77,"gross_charge":297.50,"discounted_cash":297.50,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":9.20,"standard_charge_algorithm":"Reimbursement will be 9.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care ","plan_name":"MGMCR","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRHMO","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"Cigna Healthspring","plan_name":"MCR","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"FL Health Care Plan","plan_name":"MCR","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11.38,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRHMO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Humana  ","plan_name":"MGMCRPPO","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":9.64,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Putnam County Sheriffs","plan_name":"LocalGovernment","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan ","plan_name":"MCR","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"United  ","plan_name":"MCR","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"VACCN","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"WellCare ","plan_name":"MCR","standard_charge_dollar":11.17,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":10.64,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia SCHEDULED","code_information":[{"code":"52260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5717.70,"maximum":6353.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6353.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6035.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5717.70,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant SCHEDULED","code_information":[{"code":"52441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with internal urethrotomy; female UNSCHEDULED","code_information":[{"code":"52270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with internal urethrotomy; male SCHEDULED","code_information":[{"code":"52275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18297.90,"maximum":20331.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":20331.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":19314.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":18297.90,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including fluoroscopy, when perfor UNSCHEDULED","code_information":[{"code":"52284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with steroid injection into stricture SCHEDULED","code_information":[{"code":"52283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral UNSCHEDULED","code_information":[{"code":"52301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision UNSCHEDULED","code_information":[{"code":"88147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.70,"maximum":153.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":137.70,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision UNSCHEDULED","code_information":[{"code":"88142","type":"CPT"},{"code":"L000392501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":137.70,"maximum":153.00,"gross_charge":115.50,"discounted_cash":115.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":137.70,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, concentration technique, smears and interpretation (eg, Saccomanno technique) UNSCHEDULED","code_information":[{"code":"88108","type":"CPT"},{"code":"L000391902","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":155.70,"maximum":173.00,"gross_charge":297.50,"discounted_cash":297.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":173.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":164.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":155.70,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in additi UNSCHEDULED","code_information":[{"code":"88177","type":"CPT"},{"code":"L000393901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":137.70,"maximum":153.00,"gross_charge":108.25,"discounted_cash":108.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":153.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":145.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":137.70,"methodology":"fee schedule"}]}]},{"description":"Dacryocystography, nasolacrimal duct, radiological supervision and interpretation UNSCHEDULED","code_information":[{"code":"70170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1961.10,"maximum":2179.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2179.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2070.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1961.10,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE SKIN, FULL SCHEDULED","code_information":[{"code":"11041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2312.10,"maximum":2569.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2569.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2440.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2312.10,"methodology":"fee schedule"}]}]},{"description":"DEBRIDE SKIN, PARTIAL UNSCHEDULED","code_information":[{"code":"11040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1099.80,"maximum":1222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1160.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1099.80,"methodology":"fee schedule"}]}]},{"description":"Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, de SCHEDULED","code_information":[{"code":"97598","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.00,"maximum":30.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":30.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":28.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":27.00,"methodology":"fee schedule"}]}]},{"description":"Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"11001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1099.80,"maximum":1222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1160.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1099.80,"methodology":"fee schedule"}]}]},{"description":"Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less SCHEDULED","code_information":[{"code":"11042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":524.70,"maximum":583.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":583.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":553.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":524.70,"methodology":"fee schedule"}]}]},{"description":"DECLOT VASCULAR DEVICE UNSCHEDULED","code_information":[{"code":"36550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle) with debridement of nonviable muscle, unilater SCHEDULED","code_information":[{"code":"27057","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8869.50,"maximum":9855.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9855.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9362.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8869.50,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, forearm, with brachial artery exploration UNSCHEDULED","code_information":[{"code":"24495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle and/or nerve UNSCHEDULED","code_information":[{"code":"27893","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5089.50,"maximum":5655.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5655.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5372.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5089.50,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerve UNSCHEDULED","code_information":[{"code":"27497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5215.50,"maximum":5795.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5795.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5505.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5215.50,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable muscle and/or nerve SCHEDULED","code_information":[{"code":"27499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Decompression fingers and/or hand, injection injury (eg, grease gun) UNSCHEDULED","code_information":[{"code":"26035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Decortication and parietal pleurectomy UNSCHEDULED","code_information":[{"code":"32320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1427.40,"maximum":1586.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1586.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1506.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1427.40,"methodology":"fee schedule"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips SCHEDULED","code_information":[{"code":"15630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3213.00,"maximum":3570.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3570.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3391.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3213.00,"methodology":"fee schedule"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet SCHEDULED","code_information":[{"code":"15620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4214.70,"maximum":4683.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4683.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4448.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4214.70,"methodology":"fee schedule"}]}]},{"description":"Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, inc UNSCHEDULED","code_information":[{"code":"34711","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Dengue vaccine, quadrivalent, live, 2 dose schedule, for subcutaneous use UNSCHEDULED","code_information":[{"code":"90584","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Deoxycortisol, 11- UNSCHEDULED","code_information":[{"code":"82634","type":"CPT"},{"code":"L000106401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"gross_charge":805.25,"discounted_cash":805.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"Deoxyribonucleic acid (DNA) antibody; native or double stranded UNSCHEDULED","code_information":[{"code":"86225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":132.30,"maximum":147.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":147.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":139.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":132.30,"methodology":"fee schedule"}]}]},{"description":"Deoxyribonucleic acid (DNA) antibody; single stranded UNSCHEDULED","code_information":[{"code":"86226","type":"CPT"},{"code":"L000232401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"gross_charge":144.75,"discounted_cash":144.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"Dermabrasion; segmental, face UNSCHEDULED","code_information":[{"code":"15781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children UNSCHEDULED","code_information":[{"code":"15136","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"DESTR PARAVERTEBRL NERVE C/T UNSCHEDULED","code_information":[{"code":"64626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"DESTR PARAVERTEBRL NERVE L/S SCHEDULED","code_information":[{"code":"64622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"DESTROY NERVE NECK MUSCLE SCHEDULED","code_information":[{"code":"64613","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions UNSCHEDULED","code_information":[{"code":"17004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed SCHEDULED","code_information":[{"code":"64624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for p SCHEDULED","code_information":[{"code":"64636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale SCHEDULED","code_information":[{"code":"64605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring UNSCHEDULED","code_information":[{"code":"64610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch SCHEDULED","code_information":[{"code":"64600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm UNSCHEDULED","code_information":[{"code":"17107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency) UNSCHEDULED","code_information":[{"code":"46930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion of lid margin (up to 1 cm) UNSCHEDULED","code_information":[{"code":"67850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239.30,"maximum":1377.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1377.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1239.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) UNSCHEDULED","code_information":[{"code":"46924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7845.30,"maximum":8717.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8717.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8281.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7845.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery SCHEDULED","code_information":[{"code":"46916","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2247.30,"maximum":2497.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2497.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2372.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2247.30,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) SCHEDULED","code_information":[{"code":"56515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5367.60,"maximum":5964.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5964.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5665.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5367.60,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion, palate or uvula (thermal, cryo or chemical) UNSCHEDULED","code_information":[{"code":"42160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":445.50,"maximum":495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":470.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":445.50,"methodology":"fee schedule"}]}]},{"description":"Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion) UNSCHEDULED","code_information":[{"code":"67221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4999.50,"maximum":5555.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5555.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5277.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4999.50,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm SCHEDULED","code_information":[{"code":"17282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm SCHEDULED","code_information":[{"code":"17271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm SCHEDULED","code_information":[{"code":"17273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1056.60,"maximum":1174.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1174.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1115.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1056.60,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm UNSCHEDULED","code_information":[{"code":"17261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"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 UNSCHEDULED","code_information":[{"code":"17262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.30,"maximum":487.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":487.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":438.30,"methodology":"fee schedule"}]}]},{"description":"Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when SCHEDULED","code_information":[{"code":"96112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":130.50,"maximum":145.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":145.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":137.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":130.50,"methodology":"fee schedule"}]}]},{"description":"Dexamethasone suppression panel, 48 hour This panel must include the following: Free cortisol, urine (82530 x 2) Cortisol (82533 x 2) Volume measurement for timed collection (81050 x 2) UNSCHEDULED","code_information":[{"code":"80420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118.80,"maximum":132.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":132.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":125.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":118.80,"methodology":"fee schedule"}]}]},{"description":"Diabetes outpatient self-management training services, individual, per 30 minutes SCHEDULED","code_information":[{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55.80,"maximum":62.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":62.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":58.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":55.80,"methodology":"fee schedule"}]}]},{"description":"Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"92623","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.20,"maximum":218.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":218.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":207.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":196.20,"methodology":"fee schedule"}]}]},{"description":"Dibucaine number UNSCHEDULED","code_information":[{"code":"82638","type":"CPT"},{"code":"L000106501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":65.70,"maximum":73.00,"gross_charge":339.50,"discounted_cash":339.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":73.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":65.70,"methodology":"fee schedule"}]}]},{"description":"DILATE ESOPHAGUS UNSCHEDULED","code_information":[{"code":"43456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Dilation and catheterization of salivary duct, with or without injection SCHEDULED","code_information":[{"code":"42660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"Dilation of anal sphincter (separate procedure) under anesthesia other than local SCHEDULED","code_information":[{"code":"45905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2100.60,"maximum":2334.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2334.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2217.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2100.60,"methodology":"fee schedule"}]}]},{"description":"Dilation of lacrimal punctum, with or without irrigation UNSCHEDULED","code_information":[{"code":"68801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2344.50,"maximum":2605.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2605.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2474.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2344.50,"methodology":"fee schedule"}]}]},{"description":"Dilation of ureter(s) or urethra, radiological supervision and interpretation UNSCHEDULED","code_information":[{"code":"74485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1167.30,"maximum":1297.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1297.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1232.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1167.30,"methodology":"fee schedule"}]}]},{"description":"Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent UNSCHEDULED","code_information":[{"code":"53601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6759.90,"maximum":7511.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7511.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7135.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6759.90,"methodology":"fee schedule"}]}]},{"description":"Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use UNSCHEDULED","code_information":[{"code":"90696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intr UNSCHEDULED","code_information":[{"code":"90697","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"Direct or patch closure, sinus venosus, with or without anomalous pulmonary venous drainage UNSCHEDULED","code_information":[{"code":"33645","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal ao SCHEDULED","code_information":[{"code":"35081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal ao UNSCHEDULED","code_information":[{"code":"35102","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femor SCHEDULED","code_information":[{"code":"35141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, iliac artery UNSCHEDULED","code_information":[{"code":"35131","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, radial or ul SCHEDULED","code_information":[{"code":"35045","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta SCHEDULED","code_information":[{"code":"35082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, axillary-brachial artery, by arm incision SCHEDULED","code_information":[{"code":"35013","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Disarticulation through wrist; re-amputation UNSCHEDULED","code_information":[{"code":"25924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3509.10,"maximum":3899.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3899.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3704.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3509.10,"methodology":"fee schedule"}]}]},{"description":"Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife) SCHEDULED","code_information":[{"code":"66820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3851.10,"maximum":4279.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4065.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3851.10,"methodology":"fee schedule"}]}]},{"description":"Discission of vitreous strands (without removal), pars plana approach UNSCHEDULED","code_information":[{"code":"67030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4999.50,"maximum":5555.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5555.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5277.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4999.50,"methodology":"fee schedule"}]}]},{"description":"Displacement therapy (Proetz type) SCHEDULED","code_information":[{"code":"30210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Division of aberrant vessel (vascular ring); SCHEDULED","code_information":[{"code":"33802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Division of aberrant vessel (vascular ring); with reanastomosis UNSCHEDULED","code_information":[{"code":"33803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure) UNSCHEDULED","code_information":[{"code":"28250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Division of sternocleidomastoid for torticollis, open operation; without cast application UNSCHEDULED","code_information":[{"code":"21720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4923.90,"maximum":5471.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5471.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5197.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4923.90,"methodology":"fee schedule"}]}]},{"description":"DOMICILIARY OR REST HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A DETAILED INTERVAL HISTORY; A DETAILED EXAMINATION; ME SCHEDULED","code_information":[{"code":"99336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135.00,"maximum":150.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":150.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":142.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":135.00,"methodology":"fee schedule"}]}]},{"description":"Donor enterectomy (including cold preservation), open; from cadaver donor SCHEDULED","code_information":[{"code":"44132","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments V, VI, VII and VIII) SCHEDULED","code_information":[{"code":"47142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1418.40,"maximum":1576.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1576.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1497.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1418.40,"methodology":"fee schedule"}]}]},{"description":"Donor nephrectomy (including cold preservation); open, from living donor SCHEDULED","code_information":[{"code":"50320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":857.70,"maximum":953.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":953.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":905.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":857.70,"methodology":"fee schedule"}]}]},{"description":"Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) SCHEDULED","code_information":[{"code":"93325","type":"CPT"},{"code":"C000023401","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":99.00,"maximum":110.00,"gross_charge":2041.00,"discounted_cash":2041.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":110.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":104.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":99.00,"methodology":"fee schedule"}]}]},{"description":"Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study UNSCHEDULED","code_information":[{"code":"76828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":533.70,"maximum":593.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":593.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":563.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":533.70,"methodology":"fee schedule"}]}]},{"description":"DRAIN ABDOMINAL ABSCESS SCHEDULED","code_information":[{"code":"49021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"Drainage abscess or hematoma, nasal septum SCHEDULED","code_information":[{"code":"30020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Drainage abscess or hematoma, nasal, internal approach UNSCHEDULED","code_information":[{"code":"30000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":479.70,"maximum":533.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":533.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":506.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":479.70,"methodology":"fee schedule"}]}]},{"description":"Drainage external ear, abscess or hematoma; complicated SCHEDULED","code_information":[{"code":"69005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4519.80,"maximum":5022.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5022.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4770.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4519.80,"methodology":"fee schedule"}]}]},{"description":"Drainage external ear, abscess or hematoma; simple SCHEDULED","code_information":[{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4519.80,"maximum":5022.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5022.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4770.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4519.80,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess, cyst, hematoma, vestibule of mouth; simple SCHEDULED","code_information":[{"code":"40800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2693.70,"maximum":2993.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2993.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2843.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2693.70,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess; parotid, simple SCHEDULED","code_information":[{"code":"42300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.30,"maximum":7.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6.30,"methodology":"fee schedule"}]}]},{"description":"Drainage of finger abscess; complicated (eg, felon) SCHEDULED","code_information":[{"code":"26011","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1107.90,"maximum":1231.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1231.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1169.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1107.90,"methodology":"fee schedule"}]}]},{"description":"Drainage of palmar bursa; multiple bursa UNSCHEDULED","code_information":[{"code":"26030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open SCHEDULED","code_information":[{"code":"49020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7495.20,"maximum":8328.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8328.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7911.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7495.20,"methodology":"fee schedule"}]}]},{"description":"Drainage of retroperitoneal abscess, open UNSCHEDULED","code_information":[{"code":"49060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4673.70,"maximum":5193.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5193.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4933.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4673.70,"methodology":"fee schedule"}]}]},{"description":"Drainage of scrotal wall abscess UNSCHEDULED","code_information":[{"code":"55100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11069.10,"maximum":12299.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":12299.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":11684.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":11069.10,"methodology":"fee schedule"}]}]},{"description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area) UNSCHEDULED","code_information":[{"code":"16030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.30,"maximum":327.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":327.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":310.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":294.30,"methodology":"fee schedule"}]}]},{"description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) SCHEDULED","code_information":[{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":216.90,"maximum":241.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":241.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":228.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":216.90,"methodology":"fee schedule"}]}]},{"description":"Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 4-6 UNSCHEDULED","code_information":[{"code":"80376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":118.80,"maximum":132.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":132.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":125.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":118.80,"methodology":"fee schedule"}]}]},{"description":"Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) UNSCHEDULED","code_information":[{"code":"77080","type":"CPT"},{"code":"I000159502","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":187.20,"maximum":208.00,"gross_charge":1796.75,"discounted_cash":1796.75,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":208.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":197.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":187.20,"methodology":"fee schedule"}]}]},{"description":"Duodenal motility (manometric) study SCHEDULED","code_information":[{"code":"91022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":90.00,"maximum":100.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":100.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":95.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":90.00,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study SCHEDULED","code_information":[{"code":"93975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study SCHEDULED","code_information":[{"code":"93931","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":99.90,"maximum":111.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":111.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":105.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":99.90,"methodology":"fee schedule"}]}]},{"description":"DXA BONE DENSITY/V-FRACTURE UNSCHEDULED","code_information":[{"code":"76077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.90,"maximum":561.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":561.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":532.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":504.90,"methodology":"fee schedule"}]}]},{"description":"Dynamic fine wire electromyography, during walking or other functional activities, 1 muscle SCHEDULED","code_information":[{"code":"96003","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.00,"maximum":20.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":20.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":19.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":18.00,"methodology":"fee schedule"}]}]},{"description":"Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles SCHEDULED","code_information":[{"code":"96002","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.50,"maximum":25.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":22.50,"methodology":"fee schedule"}]}]},{"description":"ECG MONITOR/RECORD, 24 HRS UNSCHEDULED","code_information":[{"code":"93231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":463.50,"maximum":515.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":515.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":489.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":463.50,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echoc SCHEDULED","code_information":[{"code":"93306","type":"CPT"},{"code":"C000022101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":127.80,"maximum":142.00,"gross_charge":3480.50,"discounted_cash":3480.50,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":142.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":134.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":127.80,"methodology":"fee schedule"}]}]},{"description":"Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report SCHEDULED","code_information":[{"code":"93005","type":"CPT"},{"code":"C000018501","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.40,"maximum":16.00,"gross_charge":107.25,"discounted_cash":107.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14.40,"methodology":"fee schedule"}]}]},{"description":"Electrocorticogram at surgery (separate procedure) UNSCHEDULED","code_information":[{"code":"95829","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":756.00,"maximum":840.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":840.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":756.00,"methodology":"fee schedule"}]}]},{"description":"Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, each increment of greater th SCHEDULED","code_information":[{"code":"95719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":161.10,"maximum":179.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":179.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":170.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":161.10,"methodology":"fee schedule"}]}]},{"description":"Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary SCHEDULED","code_information":[{"code":"95724","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":328.50,"maximum":365.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":365.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":346.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":328.50,"methodology":"fee schedule"}]}]},{"description":"Electroencephalogram (EEG); including recording awake and asleep UNSCHEDULED","code_information":[{"code":"95819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":712.80,"maximum":792.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":792.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":712.80,"methodology":"fee schedule"}]}]},{"description":"Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique SCHEDULED","code_information":[{"code":"51784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"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, UNSCHEDULED","code_information":[{"code":"95981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1189.80,"maximum":1322.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1322.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1255.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1189.80,"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, UNSCHEDULED","code_information":[{"code":"95982","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1189.80,"maximum":1322.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1322.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1255.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1189.80,"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 SCHEDULED","code_information":[{"code":"95971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42.30,"maximum":47.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":47.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":42.30,"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 SCHEDULED","code_information":[{"code":"95977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54.90,"maximum":61.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":61.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":54.90,"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 UNSCHEDULED","code_information":[{"code":"95971","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":491.40,"maximum":546.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":546.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":518.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":491.40,"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 UNSCHEDULED","code_information":[{"code":"95977","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1189.80,"maximum":1322.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1322.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1255.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1189.80,"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 UNSCHEDULED","code_information":[{"code":"95984","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1189.80,"maximum":1322.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1322.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1255.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1189.80,"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 SCHEDULED","code_information":[{"code":"62367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter; femoropopliteal, aortoiliac artery, by leg incision SCHEDULED","code_information":[{"code":"34201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter; innominate, subclavian artery, by thoracic incision UNSCHEDULED","code_information":[{"code":"34051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional SCHEDULED","code_information":[{"code":"99281","type":"CPT"},{"code":"E000000101","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":23.40,"maximum":26.00,"gross_charge":2180.00,"discounted_cash":2180.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":26.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":23.40,"methodology":"fee schedule"}]}]},{"description":"Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making SCHEDULED","code_information":[{"code":"99285","type":"CPT"},{"code":"E000000901","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":180.00,"maximum":200.00,"gross_charge":8427.00,"discounted_cash":8427.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":200.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":190.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":180.00,"methodology":"fee schedule"}]}]},{"description":"ENCEPHALITIS VACCINE SC UNSCHEDULED","code_information":[{"code":"90735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.50,"maximum":155.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":155.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":147.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":139.50,"methodology":"fee schedule"}]}]},{"description":"End-stage renal disease (ESRD) related services for home dialysis per full month, for patients 20 years of age and older SCHEDULED","code_information":[{"code":"90966","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241.20,"maximum":268.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":268.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":254.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":241.20,"methodology":"fee schedule"}]}]},{"description":"End-stage renal disease (ESRD) related services monthly, for patients 20 years of age and older; with 4 or more face-to-face visits by a physician or other qualified health care professional per month SCHEDULED","code_information":[{"code":"90960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":288.00,"maximum":320.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":320.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":304.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":288.00,"methodology":"fee schedule"}]}]},{"description":"Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, brush, forceps, and/or needle), including imaging guidance (eg, fluoroscopy), and all associated radiological supervision and UNSCHEDULED","code_information":[{"code":"47543","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1163.70,"maximum":1293.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1293.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1228.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1163.70,"methodology":"fee schedule"}]}]},{"description":"Endomyocardial biopsy UNSCHEDULED","code_information":[{"code":"93505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3429.90,"maximum":3811.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3811.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3620.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3429.90,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi SCHEDULED","code_information":[{"code":"43263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi UNSCHEDULED","code_information":[{"code":"43263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) UNSCHEDULED","code_information":[{"code":"43264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) UNSCHEDULED","code_information":[{"code":"43275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy UNSCHEDULED","code_information":[{"code":"43262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Endoscopy, wrist, surgical, with release of transverse carpal ligament UNSCHEDULED","code_information":[{"code":"29848","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4252.50,"maximum":4725.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4725.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4488.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4252.50,"methodology":"fee schedule"}]}]},{"description":"Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging guidance; each add UNSCHEDULED","code_information":[{"code":"61651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), SCHEDULED","code_information":[{"code":"34705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), SCHEDULED","code_information":[{"code":"34703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Endovascular repair of visceral aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endogra SCHEDULED","code_information":[{"code":"34841","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated SCHEDULED","code_information":[{"code":"36478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4125.60,"maximum":4584.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4584.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4354.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4125.60,"methodology":"fee schedule"}]}]},{"description":"ENT procedure/service UNSCHEDULED","code_information":[{"code":"92599","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.20,"maximum":218.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":218.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":207.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":196.20,"methodology":"fee schedule"}]}]},{"description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; each additional resection and anastomosis (List separately in addit UNSCHEDULED","code_information":[{"code":"44128","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Enterectomy, resection of small intestine for congenital atresia, single resection and anastomosis of proximal segment of intestine; without tapering SCHEDULED","code_information":[{"code":"44126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Enterocystoplasty, including intestinal anastomosis SCHEDULED","code_information":[{"code":"51960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4391.10,"maximum":4879.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4879.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4391.10,"methodology":"fee schedule"}]}]},{"description":"Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure) SCHEDULED","code_information":[{"code":"44130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1351.80,"maximum":1502.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1502.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1426.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1351.80,"methodology":"fee schedule"}]}]},{"description":"Enterolysis (freeing of intestinal adhesion) (separate procedure) UNSCHEDULED","code_information":[{"code":"44005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Enterotomy, small intestine, other than duodenum; for decompression (eg, Baker tube) UNSCHEDULED","code_information":[{"code":"44021","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children UNSCHEDULED","code_information":[{"code":"15115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"Epiglottidectomy UNSCHEDULED","code_information":[{"code":"31420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2245.50,"maximum":2495.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2370.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2245.50,"methodology":"fee schedule"}]}]},{"description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna SCHEDULED","code_information":[{"code":"25455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna SCHEDULED","code_information":[{"code":"25450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5361.30,"maximum":5957.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5957.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5659.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5361.30,"methodology":"fee schedule"}]}]},{"description":"Escharotomy; each additional incision (List separately in addition to code for primary procedure) UNSCHEDULED","code_information":[{"code":"16036","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"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 UNSCHEDULED","code_information":[{"code":"91038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1138.50,"maximum":1265.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1265.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1201.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1138.50,"methodology":"fee schedule"}]}]},{"description":"Esophageal function test, gastroesophageal reflux test with nasal catheter intraluminal impedance electrode(s) placement, recording, analysis and interpretation; SCHEDULED","code_information":[{"code":"91037","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":110.70,"maximum":123.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":123.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":116.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":110.70,"methodology":"fee schedule"}]}]},{"description":"Esophageal motility UNSCHEDULED","code_information":[{"code":"78258","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1805.40,"maximum":2006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1905.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1805.40,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) SCHEDULED","code_information":[{"code":"43235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1609.20,"maximum":1788.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1788.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1698.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1609.20,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric bariatric balloon SCHEDULED","code_information":[{"code":"43290","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) UNSCHEDULED","code_information":[{"code":"43245","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures SCHEDULED","code_information":[{"code":"43237","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices UNSCHEDULED","code_information":[{"code":"43243","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire SCHEDULED","code_information":[{"code":"43248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1398.60,"maximum":1554.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1554.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1476.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1398.60,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the eso SCHEDULED","code_information":[{"code":"43242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4363.20,"maximum":4848.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4848.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4605.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4363.20,"methodology":"fee schedule"}]}]},{"description":"Esophagojejunostomy (without total gastrectomy); abdominal approach SCHEDULED","code_information":[{"code":"43340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagoplasty (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal fistula UNSCHEDULED","code_information":[{"code":"43312","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Esophagoplasty (plastic repair or reconstruction), thoracic approach; without repair of tracheoesophageal fistula UNSCHEDULED","code_information":[{"code":"43310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; with repair of congenital tracheoesophageal fistula SCHEDULED","code_information":[{"code":"43314","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transnasal; with biopsy, single or multiple SCHEDULED","code_information":[{"code":"43198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with band ligation of esophageal varices UNSCHEDULED","code_information":[{"code":"43205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with control of bleeding, any method SCHEDULED","code_information":[{"code":"43227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination UNSCHEDULED","code_information":[{"code":"43231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire SCHEDULED","code_information":[{"code":"43226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with optical endomicroscopy SCHEDULED","code_information":[{"code":"43206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope SCHEDULED","code_information":[{"code":"43180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1557.90,"maximum":1731.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1731.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1644.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1557.90,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker's diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope UNSCHEDULED","code_information":[{"code":"43180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire UNSCHEDULED","code_information":[{"code":"43196","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1850.40,"maximum":2056.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2056.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1953.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1850.40,"methodology":"fee schedule"}]}]},{"description":"Ethmoidectomy; extranasal, total UNSCHEDULED","code_information":[{"code":"31205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Ethmoidectomy; intranasal, anterior UNSCHEDULED","code_information":[{"code":"31200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.80,"maximum":442.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":442.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":419.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":397.80,"methodology":"fee schedule"}]}]},{"description":"Evacuation of subungual hematoma SCHEDULED","code_information":[{"code":"11740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":138.60,"maximum":154.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":154.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":146.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":138.60,"methodology":"fee schedule"}]}]},{"description":"EVAL MOLECULAR PROBES 11-50 UNSCHEDULED","code_information":[{"code":"88384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":244.80,"maximum":272.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":272.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":258.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":244.80,"methodology":"fee schedule"}]}]},{"description":"Evaluation of speech fluency (eg, stuttering, cluttering) UNSCHEDULED","code_information":[{"code":"92521","type":"CPT"},{"code":"T000026301","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"gross_charge":1890.00,"discounted_cash":1890.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) SCHEDULED","code_information":[{"code":"92523","type":"CPT"},{"code":"T000026701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":193.50,"maximum":215.00,"gross_charge":1890.00,"discounted_cash":1890.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":215.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":204.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":193.50,"methodology":"fee schedule"}]}]},{"description":"Evisceration of ocular contents; without implant SCHEDULED","code_information":[{"code":"65091","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3781.80,"maximum":4202.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4202.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3991.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3781.80,"methodology":"fee schedule"}]}]},{"description":"Exchange of biliary drainage catheter (eg, external, internal-external, or conversion of internal-external to external only), percutaneous, including diagnostic cholangiography when performed, imaging SCHEDULED","code_information":[{"code":"47536","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Exchange transfusion, blood; other than newborn UNSCHEDULED","code_information":[{"code":"36455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"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 UNSCHEDULED","code_information":[{"code":"67961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1239.30,"maximum":1377.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1377.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1239.30,"methodology":"fee schedule"}]}]},{"description":"Excision distal ulna partial or complete (eg, Darrach type or matched resection) UNSCHEDULED","code_information":[{"code":"25240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5692.50,"maximum":6325.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6325.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6008.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5692.50,"methodology":"fee schedule"}]}]},{"description":"Excision inferior turbinate, partial or complete, any method UNSCHEDULED","code_information":[{"code":"30130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":479.70,"maximum":533.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":533.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":506.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":479.70,"methodology":"fee schedule"}]}]},{"description":"Excision of 1 or more lesions of small or large intestine not requiring anastomosis, exteriorization, or fistulization; multiple enterotomies UNSCHEDULED","code_information":[{"code":"44111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2240.10,"maximum":2489.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2489.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2364.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2240.10,"methodology":"fee schedule"}]}]},{"description":"Excision of Bartholin's gland or cyst SCHEDULED","code_information":[{"code":"56740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5367.60,"maximum":5964.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5964.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5665.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5367.60,"methodology":"fee schedule"}]}]},{"description":"Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesionºs») SCHEDULED","code_information":[{"code":"21048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Excision of bone (eg, for osteomyelitis or bone abscess); mandible SCHEDULED","code_information":[{"code":"21025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6004.80,"maximum":6672.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":6672.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":6338.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6004.80,"methodology":"fee schedule"}]}]},{"description":"Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion SCHEDULED","code_information":[{"code":"19125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63.00,"maximum":70.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":70.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":66.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":63.00,"methodology":"fee schedule"}]}]},{"description":"Excision of chalazion; single SCHEDULED","code_information":[{"code":"67800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4772.70,"maximum":5303.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5303.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5037.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4772.70,"methodology":"fee schedule"}]}]},{"description":"Excision of chest wall tumor including rib(s) SCHEDULED","code_information":[{"code":"21601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4602.60,"maximum":5114.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5114.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4858.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4602.60,"methodology":"fee schedule"}]}]},{"description":"Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy UNSCHEDULED","code_information":[{"code":"21602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4923.90,"maximum":5471.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5471.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5197.45,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4923.90,"methodology":"fee schedule"}]}]},{"description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; repair using either left subclavian artery or prosthetic material as gusset for enlargement UNSCHEDULED","code_information":[{"code":"33851","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis SCHEDULED","code_information":[{"code":"33840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Excision of constricting ring of finger, with multiple Z-plasties UNSCHEDULED","code_information":[{"code":"26596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod SCHEDULED","code_information":[{"code":"26415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4235.40,"maximum":4706.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4706.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4470.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4235.40,"methodology":"fee schedule"}]}]},{"description":"Excision of hydrocele of spermatic cord, unilateral (separate procedure) SCHEDULED","code_information":[{"code":"55500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3325.50,"maximum":3695.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3695.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3510.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3325.50,"methodology":"fee schedule"}]}]},{"description":"Excision of infected graft; extremity SCHEDULED","code_information":[{"code":"35903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":468.90,"maximum":521.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":521.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":494.95,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":468.90,"methodology":"fee schedule"}]}]},{"description":"Excision of infected graft; neck SCHEDULED","code_information":[{"code":"35901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputation UNSCHEDULED","code_information":[{"code":"20805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":845.10,"maximum":939.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":939.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":892.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":845.10,"methodology":"fee schedule"}]}]},{"description":"Replantation, thumb (includes carpometacarpal joint to MP joint), complete amputation SCHEDULED","code_information":[{"code":"20824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Replantation, thumb (includes carpometacarpal joint to MP joint), complete amputation UNSCHEDULED","code_information":[{"code":"20824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":845.10,"maximum":939.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":939.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":892.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":845.10,"methodology":"fee schedule"}]}]},{"description":"REPOSITIONING OF CVC SCHEDULED","code_information":[{"code":"36493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) SCHEDULED","code_information":[{"code":"66825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3261.60,"maximum":3624.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3624.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3442.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3261.60,"methodology":"fee schedule"}]}]},{"description":"Reprogramming of programmable cerebrospinal shunt UNSCHEDULED","code_information":[{"code":"62252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Resection of mediastinal cyst SCHEDULED","code_information":[{"code":"39200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4099.50,"maximum":4555.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4555.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4099.50,"methodology":"fee schedule"}]}]},{"description":"Resection or excision of neoplastic, vascular or infectious lesion of base of anterior cranial fossa; intradural, including dural repair, with or without graft SCHEDULED","code_information":[{"code":"61601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Resection or excision of neoplastic, vascular or infectious lesion of infratemporal fossa, parapharyngeal space, petrous apex; extradural UNSCHEDULED","code_information":[{"code":"61605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Resection or excision of neoplastic, vascular or infectious lesion of parasellar area, cavernous sinus, clivus or midline skull base; intradural, including dural repair, with or without graft UNSCHEDULED","code_information":[{"code":"61608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1091.70,"maximum":1213.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1213.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1152.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1091.70,"methodology":"fee schedule"}]}]},{"description":"Resection, humeral head UNSCHEDULED","code_information":[{"code":"23195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":805.50,"maximum":895.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":895.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":850.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":805.50,"methodology":"fee schedule"}]}]},{"description":"RESIDUAL LUNG CAPACITY UNSCHEDULED","code_information":[{"code":"94240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":204.30,"maximum":227.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":227.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":204.30,"methodology":"fee schedule"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additiona UNSCHEDULED","code_information":[{"code":"15274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":602.10,"maximum":669.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":669.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":635.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":602.10,"methodology":"fee schedule"}]}]},{"description":"Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code f SCHEDULED","code_information":[{"code":"15272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1016.10,"maximum":1129.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1129.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1072.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1016.10,"methodology":"fee schedule"}]}]},{"description":"APPLY ACELLULAR XGRAFT ADD UNSCHEDULED","code_information":[{"code":"15431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"APPLY SKINALLOGRFT T/ARM/LG SCHEDULED","code_information":[{"code":"15300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2364.30,"maximum":2627.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2627.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2495.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2364.30,"methodology":"fee schedule"}]}]},{"description":"APPLY SKINALLOGRFT T/ARM/LG UNSCHEDULED","code_information":[{"code":"15300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":748.80,"maximum":832.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":832.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":790.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":748.80,"methodology":"fee schedule"}]}]},{"description":"Aquaporin-4 (neuromyelitis optica ºNMO») antibody; enzyme-linked immunosorbent immunoassay (ELISA) UNSCHEDULED","code_information":[{"code":"86051","type":"CPT"},{"code":"L000224602","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":76.50,"maximum":85.00,"gross_charge":48.25,"discounted_cash":48.25,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":85.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":76.50,"methodology":"fee schedule"}]}]},{"description":"AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence UNSCHEDULED","code_information":[{"code":"81173","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.60,"maximum":104.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":104.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":98.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":93.60,"methodology":"fee schedule"}]}]},{"description":"Arrest, epiphyseal (epiphysiodesis), open; distal tibia UNSCHEDULED","code_information":[{"code":"27730","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2755.80,"maximum":3062.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3062.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2908.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2755.80,"methodology":"fee schedule"}]}]},{"description":"Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus) SCHEDULED","code_information":[{"code":"27485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6709.50,"maximum":7455.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7455.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7082.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6709.50,"methodology":"fee schedule"}]}]},{"description":"Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous SCHEDULED","code_information":[{"code":"36620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":850.50,"maximum":945.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":945.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":897.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":850.50,"methodology":"fee schedule"}]}]},{"description":"Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine ce UNSCHEDULED","code_information":[{"code":"93050","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":235.80,"maximum":262.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":262.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":248.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":235.80,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; by forearm vein transposition UNSCHEDULED","code_information":[{"code":"36820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; by upper arm basilic vein transposition SCHEDULED","code_information":[{"code":"36819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; by upper arm cephalic vein transposition UNSCHEDULED","code_information":[{"code":"36818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"ARTERY BYPASS GRAFT UNSCHEDULED","code_information":[{"code":"35651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"ARTERY X-RAYS HEAD & NECK UNSCHEDULED","code_information":[{"code":"75650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1989.00,"maximum":2210.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2210.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2099.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1989.00,"methodology":"fee schedule"}]}]},{"description":"Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent re SCHEDULED","code_information":[{"code":"20606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance UNSCHEDULED","code_information":[{"code":"20610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":868.50,"maximum":965.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":965.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":916.75,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":868.50,"methodology":"fee schedule"}]}]},{"description":"Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance SCHEDULED","code_information":[{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar SCHEDULED","code_information":[{"code":"22558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6823.80,"maximum":7582.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7582.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7202.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6823.80,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process UNSCHEDULED","code_information":[{"code":"22548","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments SCHEDULED","code_information":[{"code":"22808","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5043.60,"maximum":5604.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5604.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5323.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5043.60,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft) UNSCHEDULED","code_information":[{"code":"26842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2670.30,"maximum":2967.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2967.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2818.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2670.30,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft) UNSCHEDULED","code_information":[{"code":"24802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, great toe; metatarsophalangeal joint UNSCHEDULED","code_information":[{"code":"28750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, hip joint (including obtaining graft); UNSCHEDULED","code_information":[{"code":"27284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft) SCHEDULED","code_information":[{"code":"26862","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7872.30,"maximum":8747.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8747.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8309.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7872.30,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; each additional interspace (List se UNSCHEDULED","code_information":[{"code":"22632","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixation device UNSCHEDULED","code_information":[{"code":"27279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, Jones type procedure) UNSCHEDULED","code_information":[{"code":"28760","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis; triple SCHEDULED","code_information":[{"code":"28715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14801.40,"maximum":16446.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":16446.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":15623.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":14801.40,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis; triple UNSCHEDULED","code_information":[{"code":"28715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2014.20,"maximum":2238.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2238.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2126.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2014.20,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist) SCHEDULED","code_information":[{"code":"25446","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9275.40,"maximum":10306.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":10306.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":9790.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":9275.40,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty with prosthetic replacement; lunate UNSCHEDULED","code_information":[{"code":"25444","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3509.10,"maximum":3899.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3899.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3704.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3509.10,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft UNSCHEDULED","code_information":[{"code":"27130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":942.30,"maximum":1047.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":994.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":942.30,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, elbow; with distal humeral prosthetic replacement UNSCHEDULED","code_information":[{"code":"24361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3652.20,"maximum":4058.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4058.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3855.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3652.20,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon) SCHEDULED","code_information":[{"code":"25447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6910.20,"maximum":7678.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7678.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7294.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6910.20,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, intercarpal or carpometacarpal joints; interposition (eg, tendon) UNSCHEDULED","code_information":[{"code":"25447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3141.00,"maximum":3490.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3490.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3315.50,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3141.00,"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 UNSCHEDULED","code_information":[{"code":"62327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.30,"maximum":2577.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2577.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2448.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2319.30,"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 SCHEDULED","code_information":[{"code":"62321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"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 UNSCHEDULED","code_information":[{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1788.30,"maximum":1987.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1987.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1887.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1788.30,"methodology":"fee schedule"}]}]},{"description":"Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) SCHEDULED","code_information":[{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Injection(s); single tendon origin/insertion SCHEDULED","code_information":[{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4524.30,"maximum":5027.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5027.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4775.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4524.30,"methodology":"fee schedule"}]}]},{"description":"Injection(s); single tendon origin/insertion UNSCHEDULED","code_information":[{"code":"20551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3067.20,"maximum":3408.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3408.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3237.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3067.20,"methodology":"fee schedule"}]}]},{"description":"INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS SCHEDULED","code_information":[{"code":"64413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS UNSCHEDULED","code_information":[{"code":"64413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1415.70,"maximum":1573.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1573.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1494.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1415.70,"methodology":"fee schedule"}]}]},{"description":"Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) SCHEDULED","code_information":[{"code":"64520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Injection, anesthetic agent; stellate ganglion (cervical sympathetic) SCHEDULED","code_information":[{"code":"64510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Injection, anesthetic agent; superior hypogastric plexus SCHEDULED","code_information":[{"code":"64517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3065.40,"maximum":3406.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3406.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3235.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3065.40,"methodology":"fee schedule"}]}]},{"description":"Injection, anterior chamber of eye (separate procedure); medication SCHEDULED","code_information":[{"code":"66030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3851.10,"maximum":4279.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4279.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4065.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3851.10,"methodology":"fee schedule"}]}]},{"description":"INJECTION, CARDIAC CATH UNSCHEDULED","code_information":[{"code":"93540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10276.20,"maximum":11418.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":11418.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":10847.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":10276.20,"methodology":"fee schedule"}]}]},{"description":"Injection, epidural, of blood or clot patch SCHEDULED","code_information":[{"code":"62273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6888.60,"maximum":7654.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":7654.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7271.30,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":6888.60,"methodology":"fee schedule"}]}]},{"description":"Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using tota SCHEDULED","code_information":[{"code":"99254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172.80,"maximum":192.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":182.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":172.80,"methodology":"fee schedule"}]}]},{"description":"INSERT ABDOM DRAIN, TEMP SCHEDULED","code_information":[{"code":"49420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"INSERT ABDOM DRAIN, TEMP UNSCHEDULED","code_information":[{"code":"49420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4673.70,"maximum":5193.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5193.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4933.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4673.70,"methodology":"fee schedule"}]}]},{"description":"INSERT CATHETER BILE DUCT SCHEDULED","code_information":[{"code":"47510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.70,"maximum":233.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":233.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":221.35,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":209.70,"methodology":"fee schedule"}]}]},{"description":"Insert ICD lead-oth appr UNSCHEDULED","code_information":[{"code":"33247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"INSERT KIDNEY DRAIN UNSCHEDULED","code_information":[{"code":"50392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":905.40,"maximum":1006.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1006.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":955.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":905.40,"methodology":"fee schedule"}]}]},{"description":"Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach UNSCHEDULED","code_information":[{"code":"66183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3596.40,"maximum":3996.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3996.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3796.20,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3596.40,"methodology":"fee schedule"}]}]},{"description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external revision, or closure SCHEDULED","code_information":[{"code":"36815","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4543.20,"maximum":5048.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5048.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4795.60,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4543.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to vein UNSCHEDULED","code_information":[{"code":"36800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report SCHEDULED","code_information":[{"code":"49441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF HEART PACEMAKER UNSCHEDULED","code_information":[{"code":"33200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"INSERTION OF HEART PACEMAKER UNSCHEDULED","code_information":[{"code":"33201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of indwelling tunneled pleural catheter with cuff SCHEDULED","code_information":[{"code":"32550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2166.30,"maximum":2407.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2286.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2166.30,"methodology":"fee schedule"}]}]},{"description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in SCHEDULED","code_information":[{"code":"22870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5043.60,"maximum":5604.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5604.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5323.80,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5043.60,"methodology":"fee schedule"}]}]},{"description":"Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in UNSCHEDULED","code_information":[{"code":"22870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7379.10,"maximum":8199.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":8199.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":7789.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":7379.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous SCHEDULED","code_information":[{"code":"22859","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4824.00,"maximum":5360.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5360.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5092.00,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4824.00,"methodology":"fee schedule"}]}]},{"description":"Insertion of intra-aortic balloon assist device through the ascending aorta SCHEDULED","code_information":[{"code":"33973","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of ocular implant secondary; after enucleation, muscles attached to implant UNSCHEDULED","code_information":[{"code":"65140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2681.10,"maximum":2979.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2979.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2830.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2681.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of ocular implant secondary; after enucleation, muscles not attached to implant UNSCHEDULED","code_information":[{"code":"65135","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2681.10,"maximum":2979.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2979.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2830.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2681.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of ocular implant secondary; after evisceration, in scleral shell UNSCHEDULED","code_information":[{"code":"65130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2681.10,"maximum":2979.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2979.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2830.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2681.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision a UNSCHEDULED","code_information":[{"code":"36573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2258.10,"maximum":2509.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2509.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2383.55,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2258.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of subcutaneous implantable defibrillator electrode SCHEDULED","code_information":[{"code":"33271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of subcutaneous implantable defibrillator electrode UNSCHEDULED","code_information":[{"code":"33271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter SCHEDULED","code_information":[{"code":"61215","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2314.80,"maximum":2572.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2572.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2443.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2314.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of temporary indwelling bladder catheter; simple (eg, Foley) UNSCHEDULED","code_information":[{"code":"51702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2860.20,"maximum":3178.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3178.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3019.10,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2860.20,"methodology":"fee schedule"}]}]},{"description":"Insertion of tissue expander(s) for other than breast, including subsequent expansion UNSCHEDULED","code_information":[{"code":"11960","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":560.70,"maximum":623.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":623.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":591.85,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":560.70,"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) UNSCHEDULED","code_information":[{"code":"36565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.30,"maximum":3217.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3217.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3056.15,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2895.30,"methodology":"fee schedule"}]}]},{"description":"Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, con SCHEDULED","code_information":[{"code":"49418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5140.80,"maximum":5712.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":5712.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":5426.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":5140.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of vascular pedicle into carpal bone (eg, Hori procedure) UNSCHEDULED","code_information":[{"code":"25430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3509.10,"maximum":3899.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":3899.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":3704.05,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":3509.10,"methodology":"fee schedule"}]}]},{"description":"Insertion of ventricular assist device, implantable intracorporeal, single ventricle SCHEDULED","code_information":[{"code":"33979","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Insertion of ventricular assist device, percutaneous, including radiological supervision and interpretation; right heart, venous access only SCHEDULED","code_information":[{"code":"33995","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber UNSCHEDULED","code_information":[{"code":"33249","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":442.80,"maximum":492.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":492.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":467.40,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":442.80,"methodology":"fee schedule"}]}]},{"description":"Insertion, nasal septal prosthesis (button) SCHEDULED","code_information":[{"code":"30220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4171.50,"maximum":4635.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":4635.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":4403.25,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":4171.50,"methodology":"fee schedule"}]}]},{"description":"Insertion, subcutaneous cardiac rhythm monitor, including programming SCHEDULED","code_information":[{"code":"33285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8461.80,"maximum":9402.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":9402.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":8931.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":8461.80,"methodology":"fee schedule"}]}]},{"description":"Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agent for break up of multiloculated effusion); subsequent day UNSCHEDULED","code_information":[{"code":"32562","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1427.40,"maximum":1586.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":1586.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":1506.70,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":1427.40,"methodology":"fee schedule"}]}]},{"description":"Instillation, via chest tube/catheter, agent for pleurodesis (eg, talc for recurrent or persistent pneumothorax) SCHEDULED","code_information":[{"code":"32560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2166.30,"maximum":2407.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":2407.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":2286.65,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":2166.30,"methodology":"fee schedule"}]}]},{"description":"INTAC PSYTX 45-50 MIN W/E&M UNSCHEDULED","code_information":[{"code":"90813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199.80,"maximum":222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":210.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":199.80,"methodology":"fee schedule"}]}]},{"description":"INTAC PSYTX HSP 20-30 W/E&M UNSCHEDULED","code_information":[{"code":"90824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199.80,"maximum":222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":222.00,"methodology":"fee schedule"},{"payer_name":"CorVel Corporation","plan_name":"WORKERSCOMP","standard_charge_dollar":210.90,"methodology":"fee schedule"},{"payer_name":"Prime Health","plan_name":"WC","standard_charge_dollar":199.80,"methodology":"fee schedule"}]}]},{"description":"INTAC PSYTX OFF 75-80 MIN UNSCHEDULED","code_information":[{"code":"90814","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199.80,"maximum":222.00,"payers_information":[{"payer_name":"Careworks (Rockport Community)","plan_name":"WORKERSCOMP","standard_charge_dollar":222.00,"meth