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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":5580.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":6581.22,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":5317.63,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":5317.63,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":5317.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":6190.91,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":5528.23,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":5528.23,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":5975.75,"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. 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"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47032.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":11361.43,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11256.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":11151.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":13149.80,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10625.04,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10625.04,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10625.04,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12369.93,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":11045.83,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":11045.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11940.02,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":5525.78,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10519.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":11995.40,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":22934.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":15957.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11995.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15791.55,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11995.40,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":14262.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":14262.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16865.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":41570.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16865.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11995.40,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":18535.59,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13697.72,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":15533.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":29766.37,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":43166.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":15251.07,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":15109.86,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":14403.79,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15251.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. 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"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":16632.68,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":17611.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":5920.67,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":16306.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":15872.03,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":16494.46,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":17583.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":9881.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13008.10,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9881.06,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":15716.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":15716.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13893.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":34243.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13893.08,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":9881.06,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":20425.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":15093.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":17116.89,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":32800.59,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47566.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":16805.67,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16650.07,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15872.03,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16805.67,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":16494.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":19451.01,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":15716.42,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":15716.42,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":15716.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18297.44,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":16338.85,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":16338.85,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":17661.52,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":9881.06,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":15560.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14876.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":15560.81,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":15249.59,"methodology":"fee schedule"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":4396.38,"maximum":22003.50,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":4598.73,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4644.72,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":4966.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4690.70,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4874.65,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":5196.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6349.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8358.52,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6349.20,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":4644.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":4644.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8927.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22003.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8927.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6349.20,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6036.25,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4460.77,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":5058.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":9693.64,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":14057.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4966.63,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4920.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4690.70,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4966.63,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":4644.72,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":5012.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4810.27,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4460.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":4874.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":5748.41,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":4644.72,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":4644.72,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":4644.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5407.49,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":4828.66,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":4828.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":5219.56,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":6349.20,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":4598.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4396.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":4598.73,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":4506.75,"methodology":"fee schedule"}]}]},{"description":"OTHER EAR, NOSE, MOUTH AND THROAT O.R. 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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":16709.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":31803.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":14343.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10286.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13541.94,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10286.58,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":12820.40,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":12820.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14463.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35648.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14463.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10286.58,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16661.35,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12312.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":13962.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":26756.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38801.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13708.95,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13582.01,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12947.34,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13708.95,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":13455.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":15866.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":12820.40,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":12820.40,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":12820.40,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14925.83,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":13328.14,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":13328.14,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":14407.09,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":10286.58,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":12693.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":32223.75,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20478.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":26959.16,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20478.42,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":28801.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":28801.76,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28793.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":70969.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28793.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20478.42,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":37430.66,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":27661.09,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":31368.25,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":60110.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":87169.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":30797.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":30512.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":29086.92,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30797.92,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":28801.76,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":31083.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":29828.35,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":27661.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":30227.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":35645.74,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":28801.76,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":28801.76,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":28801.76,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":33531.71,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":29942.42,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":29942.42,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":32366.33,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":20478.42,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":28516.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27261.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":11536.59,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11989.00,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":12780.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":24557.45,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":32329.08,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":24557.45,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":11423.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":11423.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":34528.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":85105.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":34528.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":24557.45,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14845.92,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10971.07,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":12441.42,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":23841.13,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":34573.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":12215.21,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":12102.11,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11536.59,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12215.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":6057.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":6545.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":31445.57,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":22722.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":29912.79,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":22722.02,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":28106.22,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":28106.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":31947.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":78744.35,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":31947.87,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":22722.02,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":36526.74,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26993.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":30610.73,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":58658.43,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":85064.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":30054.18,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":29775.90,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":28384.50,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":30054.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":29497.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":34784.92,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":28106.22,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":28106.22,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":28106.22,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":32721.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":29219.34,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":29219.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":31584.71,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":22722.02,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":27827.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":11054.53,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":14816.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":19505.15,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":14816.28,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9880.60,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9880.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":20832.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":51346.61,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":20832.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":14816.28,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12840.79,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9489.29,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":10761.05,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":20621.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":29904.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10565.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10467.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9978.43,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10565.39,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":9880.60,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":10663.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10232.78,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9489.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10369.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12228.47,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":9880.60,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":9880.60,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":9880.60,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11503.24,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":10271.91,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":10271.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11103.45,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":14816.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":9782.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":15013.20,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":8873.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":11681.64,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":8873.48,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":13418.88,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":13418.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":12476.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":30751.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":12476.39,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":8873.48,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":17439.12,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12887.44,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":14614.62,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":28005.56,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":40612.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":14348.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":14216.04,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":14083.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":16607.53,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":13418.88,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":13418.88,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":13418.88,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":15622.58,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":13950.32,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":13950.32,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":15079.63,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":8873.48,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":13286.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":30805.88,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":33299.69,"methodology":"fee schedule"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":15142.00,"methodology":"case rate"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":29338.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5000.00,"methodology":"per diem","additional_payer_notes":" If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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thermoplastic or equal, molded to model ","code_information":[{"code":"L5580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2682.01,"maximum":4009.19,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":2764.96,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":2958.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":2847.91,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":3041.46,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":2930.86,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":2903.21,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":2820.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":2820.26,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3152.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":3041.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":2958.51,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3041.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":2764.96,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":2958.51,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":3013.81,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3041.46,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":2903.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":2682.01,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":2764.96,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":4009.19,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":2903.21,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":2820.26,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":2764.96,"methodology":"fee 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Plan","plan_name":"MCR","standard_charge_dollar":3626.25,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":3592.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":3489.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":3489.41,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3899.93,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":3763.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":3660.46,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3763.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3420.99,"methodology":"fee 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Plan","plan_name":"MCR","standard_charge_dollar":3489.41,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":3420.99,"methodology":"fee schedule"}]}]},{"description":"Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, ","code_information":[{"code":"L6580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1899.84,"maximum":2839.97,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1958.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":2095.70,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":2017.36,"methodology":"fee schedule"},{"payer_name":"Alignment 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Plan","plan_name":"MCR","standard_charge_dollar":2839.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":2056.53,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":1997.77,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":1958.60,"methodology":"fee schedule"}]}]},{"description":"Prescription drug monitoring, evaluation of 65 common drug by LCMS/MS, urine, each drug reported detected or not detected ","code_information":[{"code":"0093U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":62.14,"maximum":90.10,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":8.20,"standard_charge_algorithm":"Reimbursement will be 8.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":64.00,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":68.35,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":65.87,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":77.67,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":70.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":66.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":67.73,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":68.35,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":73.95,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":90.10,"methodology":"fee 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Plan","plan_name":"MCR","standard_charge_dollar":63.60,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":63.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":61.20,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":61.20,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":75.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":68.40,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":66.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":64.20,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":66.00,"methodology":"fee schedule"},{"payer_name":"Devoted 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Health","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":13.20,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13.32,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":7.41,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":17.56,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12.72,"methodology":"fee 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":11070.76,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":11504.91,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":12264.67,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11696.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15397.58,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11696.13,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":10962.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":10962.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16445.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":40533.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16445.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11696.13,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14246.47,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10528.08,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":11939.06,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":22878.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":33177.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":11721.99,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11613.45,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":11070.76,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11721.99,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":10962.23,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":11830.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":11352.96,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":10528.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":11504.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":13567.11,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10962.23,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10962.23,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10962.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12762.49,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":11396.37,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":11396.37,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12318.94,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":11696.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10853.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10376.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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Care","plan_name":"MCR","standard_charge_dollar":1535.70,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1478.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1578.75,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1521.34,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":1506.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":1463.93,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":1463.93,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1636.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":1578.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":1535.70,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1578.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1435.23,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1535.70,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":1564.40,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1578.75,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1506.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1392.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":1435.23,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":2081.08,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":1506.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":1463.93,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":1435.23,"methodology":"fee schedule"}]}]},{"description":"Replace quadrilateral socket brim, custom fitted ","code_information":[{"code":"L4030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":538.81,"maximum":805.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":555.47,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":594.35,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":572.13,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":611.02,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":588.80,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":583.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":566.58,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":566.58,"methodology":"fee 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","code_information":[{"code":"K0602","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":8.14,"maximum":12.17,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8.39,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":8.98,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":8.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":9.23,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8.89,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":8.81,"methodology":"fee 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","code_information":[{"code":"A4633","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":54.32,"maximum":81.20,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.00,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":59.92,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":57.68,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":61.60,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":59.36,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":58.80,"methodology":"fee 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"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":21402.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":12102.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":9328.34,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":19299.95,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":25407.75,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":19299.95,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":8337.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":8337.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":27136.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":66884.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":27136.33,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":19299.95,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":10835.66,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8007.51,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":9080.68,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":17401.04,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":25234.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":8915.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8833.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8420.27,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":8915.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":8750.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":10318.96,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":8337.72,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":8337.72,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":8337.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9706.97,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":8667.92,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":8667.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":9369.61,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":19299.95,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":8255.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":27595.83,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":28678.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":30571.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21051.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":27713.31,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21051.27,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":27325.29,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":27325.29,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":29598.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":72954.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":29598.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21051.27,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":35511.84,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":26243.10,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":29760.21,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":57028.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":82701.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":29219.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28948.57,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":27595.83,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":29219.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":27325.29,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":29489.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":28299.26,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":26243.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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","plan_name":"MCR","standard_charge_dollar":198.57,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":212.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":204.53,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":218.43,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":210.48,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":208.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":202.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":202.54,"methodology":"fee 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Plans","plan_name":"MCR","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":0.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":0.60,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":0.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":0.60,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of 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water/saline, 500 ml ","code_information":[{"code":"A4217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.15,"maximum":6.21,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4.41,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4.71,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4.54,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee 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","code_information":[{"code":"118","type":"RC"},{"code":"C0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31659.34,"maximum":43531.60,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41948.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":31659.34,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":37595.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":43531.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee 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State","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":38782.70,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"128","type":"RC"},{"code":"C0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31659.34,"maximum":43531.60,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":41948.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":31659.34,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":37595.47,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":43531.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":42740.12,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":41157.15,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":43135.86,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":37595.47,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":38386.96,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":41157.15,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":41157.15,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":41157.15,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":39574.18,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":38782.70,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"158","type":"RC"},{"code":"D0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28930.71,"maximum":39779.72,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":36163.38,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":36163.38,"methodology":"fee schedule"},{"payer_name":"American Health 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schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":35078.48,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":37609.92,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":37609.92,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":37609.92,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":36163.38,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":35440.12,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"158","type":"RC"},{"code":"B0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29193.57,"maximum":40141.16,"payers_information":[{"payer_name":"Align Senior 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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":7803.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":4926.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":6485.40,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":4926.37,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":6974.37,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":6974.37,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":6926.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17072.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":6926.62,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":4926.37,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9063.87,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6698.16,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":7595.85,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":14555.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":21108.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":7457.74,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7388.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":7043.42,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":7457.74,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":6974.37,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":7526.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7222.96,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":6698.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":7319.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":8631.65,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":6974.37,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":6974.37,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":6974.37,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8119.73,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":7250.58,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":7250.58,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":7837.53,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":4926.37,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":6905.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6601.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":6905.32,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":6767.21,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 28.75 & M < 40.65 ","code_information":[{"code":"118","type":"RC"},{"code":"B0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":37693.78,"maximum":51828.94,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":47117.22,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":47117.22,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":49944.26,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":37693.78,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":44761.36,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":51828.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":47117.22,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":50886.60,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":49001.91,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":51357.77,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":44761.36,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":45703.71,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":49001.91,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":49001.91,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":49001.91,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":47117.22,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":46174.88,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; 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M > 28.75 & M < 40.65 ","code_information":[{"code":"128","type":"RC"},{"code":"D0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28197.83,"maximum":38772.02,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":35247.29,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":35247.29,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":37362.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":28197.83,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":33484.92,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":38772.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":35247.29,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38067.07,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":36657.18,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":38419.55,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":33484.92,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":34189.87,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":36657.18,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":36657.18,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":36657.18,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":35247.29,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":34542.34,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; 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M > 40.65 & M < 44.25 ","code_information":[{"code":"148","type":"RC"},{"code":"A0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20726.22,"maximum":28498.55,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":25907.78,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":25907.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":27462.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":20726.22,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":24612.39,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":28498.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":25907.78,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":27980.40,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":26944.09,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":28239.48,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":24612.39,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":25130.54,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":26944.09,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":26944.09,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":26944.09,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":25907.78,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":25389.62,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 40.65 & M < 44.25 ","code_information":[{"code":"118","type":"RC"},{"code":"B0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29426.43,"maximum":40461.35,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38990.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":29426.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":34943.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40461.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39725.68,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":40093.51,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":34943.89,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":35679.55,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":36047.38,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 40.65 & M < 44.25 ","code_information":[{"code":"138","type":"RC"},{"code":"B0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29426.43,"maximum":40461.35,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":38990.02,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":29426.43,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":34943.89,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":40461.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":39725.68,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":40093.51,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":34943.89,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":35679.55,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":38254.36,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":36783.04,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":36047.38,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":6660.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":7854.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":6346.71,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":6346.71,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":6346.71,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7388.99,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":6598.06,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":6598.06,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":7132.19,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":4917.51,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":6283.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6007.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":6283.87,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":6158.19,"methodology":"fee schedule"}]}]},{"description":"Underarm pad, crutch, replacement, each ","code_information":[{"code":"A4635","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":5.74,"maximum":8.58,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":5.92,"methodology":"fee schedule"},{"payer_name":"Align Senior 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","code_information":[{"code":"L6691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":393.90,"maximum":588.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":406.08,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":434.51,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":418.26,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":446.69,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":430.44,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":426.38,"methodology":"fee 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"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":30279.77,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":29674.17,"methodology":"fee schedule"}]}]},{"description":"VIRAL ILLNESS WITH MCC ","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":5828.59,"maximum":32601.16,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":10665.09,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":10771.74,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":11518.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":12051.55,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5828.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7673.14,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5828.59,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":10771.74,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":10771.74,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8195.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":20199.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8195.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5828.59,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13998.91,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":10345.14,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":11731.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":22480.91,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":32601.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":11518.30,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":11411.65,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10878.39,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11518.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":11305.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":13331.36,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10771.74,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10771.74,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10771.74,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12540.72,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":11198.34,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":11198.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12104.88,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":5828.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10665.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":6520.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6776.56,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":7224.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5021.99,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":6611.28,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5021.99,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":6456.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":6456.91,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":7061.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":17403.96,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":7061.07,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5021.99,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":8391.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6201.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":7032.28,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":13475.75,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":19542.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":6904.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":6840.49,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":6520.84,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":6904.42,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":6776.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":7991.23,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":6456.91,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":6456.91,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":6456.91,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7517.30,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":6712.63,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":6712.63,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":7256.03,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":5021.99,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":6392.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":12695.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":13193.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":14064.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11636.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15319.48,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11636.81,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":12570.80,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":12570.80,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16361.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":40327.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16361.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11636.81,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":16336.96,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":12072.95,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":13690.97,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":26235.60,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":38046.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":13442.05,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":13317.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":12695.27,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":13442.05,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":12570.80,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":13566.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":13018.87,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":12072.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":13193.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":15557.92,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":12570.80,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":12570.80,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":12570.80,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":14635.23,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":13068.66,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":13068.66,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":14126.60,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":11636.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":12446.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":12446.34,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":12197.41,"methodology":"fee schedule"}]}]},{"description":"Vitamin A ","code_information":[{"code":"84590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.52,"maximum":16.83,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent 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rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":14.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":13.24,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":12.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring 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Health Plan","plan_name":"MCR","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":11.61,"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":88.20,"maximum":127.89,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":3426.96,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":3394.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":3297.64,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":3297.64,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3685.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":3556.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":3459.29,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":3556.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":3232.98,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":3459.29,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":3523.95,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":3556.28,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":3394.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":3135.99,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":3232.98,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":4687.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":3394.63,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":3297.64,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":3232.98,"methodology":"fee schedule"}]}]},{"description":"ACUTE MAJOR EYE INFECTIONS WITH CC/MCC ","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":5662.13,"maximum":25691.72,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":8404.75,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":8488.79,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":9077.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":8572.84,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":8909.03,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":9497.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5662.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7454.01,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5662.13,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":8488.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":8488.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":7961.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":19622.42,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":7961.14,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5662.13,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":11032.00,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":8152.60,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":9245.22,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":17716.34,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":25691.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":9077.12,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":8993.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":8572.84,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":9077.12,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":8488.79,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":9161.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8791.36,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8152.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":8909.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":10505.93,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":8488.79,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":8488.79,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":8488.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":9882.86,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":8824.98,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":8824.98,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":9539.39,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":5662.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":8404.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8034.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":8404.75,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":8236.65,"methodology":"fee schedule"}]}]},{"description":"Addition to ctlso or scoliosis orthosis, outrigger ","code_information":[{"code":"913124","type":"CDM"},{"code":"L1080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":75.38,"maximum":112.68,"gross_charge":1018.76,"discounted_cash":1018.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":77.71,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":80.04,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":85.48,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":82.37,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":81.60,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":88.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":85.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":85.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":77.71,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":83.15,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":84.70,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":85.48,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":81.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":75.38,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":77.71,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":112.68,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":81.60,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":79.26,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":77.71,"methodology":"fee schedule"}]}]},{"description":"Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint ","code_information":[{"code":"L2425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":164.49,"maximum":245.89,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":169.58,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":181.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":174.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":186.54,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":179.75,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":178.06,"methodology":"fee 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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":11555.90,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6737.89,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8870.22,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6737.89,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":10328.72,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":10328.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9473.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":23350.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9473.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6737.89,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13423.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9919.67,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":11249.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":21556.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":31260.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":11044.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10942.31,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":10430.99,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":11044.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":10328.72,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":11146.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":10696.88,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9919.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10840.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12783.07,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10328.72,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10328.72,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10328.72,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":12024.95,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":10737.78,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":10737.78,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11607.03,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":6737.89,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":10226.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9776.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":10226.46,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":10021.93,"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":17.37,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":8.20,"standard_charge_algorithm":"Reimbursement will be 8.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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","code_information":[{"code":"E0974","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":82.16,"maximum":122.81,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":84.70,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":90.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":87.24,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":93.17,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":89.78,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":88.94,"methodology":"fee 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schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":37.81,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":41.05,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":38.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":36.01,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":38.53,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":39.25,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":39.61,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":37.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":34.93,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":36.01,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":52.21,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":37.81,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":36.73,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":36.01,"methodology":"fee schedule"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full sequence analysis ","code_information":[{"code":"81302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527.87,"maximum":765.41,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":25471.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":10170.59,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":13389.25,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":10170.59,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":22766.69,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":22766.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":14300.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":35246.71,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":14300.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":10170.59,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":29587.51,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":21865.04,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":24795.41,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":47514.70,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":68904.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":24344.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":24119.17,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":22992.11,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":24344.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 7. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":23893.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":28176.60,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":22766.69,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":22766.69,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":22766.69,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":26505.54,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":23668.34,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":23668.34,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":25584.35,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":10170.59,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":22541.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":22541.28,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":22090.45,"methodology":"fee schedule"}]}]},{"description":"MINOR SKIN DISORDERS WITHOUT MCC ","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":4577.52,"maximum":19091.52,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":6245.57,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":6308.02,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":6745.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":6370.48,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":6620.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10712.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12632.23,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10206.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10206.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10206.84,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11883.05,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":10611.07,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":10611.07,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11470.06,"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. 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"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":51296.33,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":50270.40,"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":1122.88,"maximum":1678.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":1157.61,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":1238.64,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1192.34,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":1273.37,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":1227.07,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":1215.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":1180.76,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":1180.76,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":1319.68,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":1273.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":1238.64,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":1273.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":1157.61,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":1238.64,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":1261.79,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":1273.37,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":1215.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":1122.88,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":1157.61,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":1678.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":1215.49,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":1180.76,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":1157.61,"methodology":"fee schedule"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":12309.78,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":12792.51,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":11441.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":15901.78,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":20934.18,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":15901.78,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":10226.54,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":10226.54,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":22358.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":55108.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":22358.40,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":15901.78,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":13290.38,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9821.53,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":11137.82,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":21343.08,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":30951.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10935.31,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":10834.06,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":10732.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":12656.61,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":10226.54,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":10226.54,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":10226.54,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":11906.00,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":10631.55,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":10631.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":11492.20,"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. 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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":4629.06,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":6385.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":8406.31,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":6385.50,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":4137.47,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":4137.47,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":8978.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":22129.30,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":8978.22,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":6385.50,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5377.05,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":3973.61,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":4506.16,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":8635.02,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":12522.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4424.23,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4383.26,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4178.44,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4424.23,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. 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"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":6385.50,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":4096.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3916.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":21135.73,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16897.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":22245.48,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16897.86,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":18891.23,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":18891.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":23758.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58560.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":23758.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16897.86,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":24550.97,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18143.06,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":20574.61,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":39426.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":57175.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":20200.53,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":20013.48,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":19078.27,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":20200.53,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":18891.23,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":20387.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":19564.58,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":18143.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":19826.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":23380.24,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":18891.23,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":18891.23,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":18891.23,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21993.63,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":19639.40,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":19639.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":21229.26,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":16897.86,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":18704.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17881.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":18704.19,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":18330.11,"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":8000.00,"maximum":58560.41,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":9318.13,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":9411.31,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":10063.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":9504.49,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":9877.22,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":20274.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":9780.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":18616.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":10529.49,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":16897.86,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":22245.48,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":16897.86,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":9411.31,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":9411.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":23758.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":58560.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":23758.92,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":16897.86,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12230.91,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":9038.59,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":10249.95,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":19641.66,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":28483.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":10063.58,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":9970.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":9504.49,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":10063.58,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":9411.31,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":10156.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":9746.77,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":9038.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":13160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":5115.99,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":5316.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":5667.72,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":7005.28,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":9222.23,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":7005.28,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":5065.83,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":5065.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":9849.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24277.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":9849.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":7005.28,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6583.54,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4865.21,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":5517.24,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":10572.53,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":15331.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":5416.93,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":5366.77,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":5115.99,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":5416.93,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":5065.83,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":5467.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":5246.40,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4865.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":5316.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":6269.60,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":5065.83,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":5065.83,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":5065.83,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5897.77,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":5266.46,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":5266.46,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":5692.79,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":7005.28,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":5015.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":24889.78,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":24391.98,"methodology":"fee schedule"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":10799.00,"maximum":109723.00,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":18079.85,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_dollar":84839.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":18260.65,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_dollar":84839.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":56938.00,"methodology":"case rate"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":19526.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":18441.45,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":19164.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":88840.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":35859.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":81572.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":20430.23,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":21735.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":28614.31,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":21735.68,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":18260.65,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":18260.65,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":30561.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":75326.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":30561.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":21735.68,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":23731.47,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":17537.45,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":19887.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":77639.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":109723.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":19526.24,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":19345.44,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":18441.45,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":19526.24,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":18260.65,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":19707.04,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":19182.72,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":17537.45,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":19164.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":22599.81,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":18260.65,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":18260.65,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":18260.65,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":21259.49,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":18983.84,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":18983.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":20520.63,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":21735.68,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":18079.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":39379.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17284.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":29429.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":18079.85,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":17718.25,"methodology":"fee schedule"}]}]},{"description":"OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2951.04,"maximum":14037.00,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":4385.56,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":4429.41,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":4736.40,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4473.27,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4648.69,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":4955.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":2951.04,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":3884.94,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":2951.04,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":4429.41,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":4429.41,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":4149.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":10226.98,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":4149.25,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":2951.04,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5756.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4253.99,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":4824.11,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":9244.30,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13405.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4736.40,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4692.54,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 1. 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"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":8827.44,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":16237.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":13102.15,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":5885.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  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","code_information":[{"code":"158","type":"RC"},{"code":"C1504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26372.07,"maximum":36261.60,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":32965.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":32965.09,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":34943.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":26372.07,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":31316.84,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":36261.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":32965.09,"methodology":"fee 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If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9718.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":4477.69,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":4653.29,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":14037.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":6771.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HMOFI","standard_charge_dollar":12887.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":4960.58,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":11696.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":15397.58,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":11696.13,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":4433.79,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":4433.79,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16445.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":40533.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":16445.13,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":11696.13,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":5762.14,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":4258.20,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":4828.88,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":9253.44,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":13419.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":4741.08,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":4697.18,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":4477.69,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":4741.08,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":4433.79,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":4784.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":4591.83,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":4258.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":4653.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":5487.36,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":4433.79,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":4433.79,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":4433.79,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":5161.93,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":4609.39,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":4609.39,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":4982.53,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":11696.13,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":4389.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4196.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":4389.89,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":4302.09,"methodology":"fee schedule"}]}]},{"description":"Replace leather cuff kafo-afo, calf or distal thigh ","code_information":[{"code":"L4110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":90.50,"maximum":135.28,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":93.30,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":99.83,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":96.10,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":102.63,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":98.90,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":95.17,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":95.17,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":106.36,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":102.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":99.83,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":102.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":93.30,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":99.83,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":101.70,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":102.63,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":90.50,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":93.30,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":135.28,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":97.97,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":95.17,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":93.30,"methodology":"fee schedule"}]}]},{"description":"Replace pretibial shell ","code_information":[{"code":"L4130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":622.86,"maximum":931.07,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":642.12,"methodology":"fee schedule"},{"payer_name":"Align 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If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11007.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":8000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":11514.16,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":11283.88,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 30.05 & M < 34.25 ","code_information":[{"code":"158","type":"RC"},{"code":"C0106","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36009.45,"maximum":49512.99,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":45011.81,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":45011.81,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":47712.52,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":36009.45,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":42761.22,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":49512.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":45011.81,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":48612.76,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":46812.29,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of 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","code_information":[{"code":"118","type":"RC"},{"code":"B0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36505.18,"maximum":50194.62,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":45631.47,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":45631.47,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":48369.36,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":36505.18,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":43349.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":50194.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":45631.47,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":49281.99,"methodology":"fee schedule"},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":47456.73,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":49738.30,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":43349.90,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":44262.53,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":47456.73,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":47456.73,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":47456.73,"methodology":"fee schedule"},{"payer_name":"Sunshine 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Healthcare","plan_name":"PFFS","standard_charge_dollar":28663.84,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":28663.84,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":27561.39,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":27010.16,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"138","type":"RC"},{"code":"C0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25317.76,"maximum":34811.92,"payers_information":[{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":31647.20,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":31647.20,"methodology":"fee schedule"},{"payer_name":"American Health 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","code_information":[{"code":"681","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":6001.00,"maximum":9000.00,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":42.90,"standard_charge_algorithm":"Reimbursement will be 42.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NonGatedCOMM","standard_charge_percentage":42.90,"standard_charge_algorithm":"Reimbursement will be 42.9% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":31.00,"standard_charge_algorithm":"Reimbursement will be 31% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Align Senior 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"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":7065.54,"methodology":"fee schedule"},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":7342.62,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":7827.51,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":5392.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":7098.50,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":5392.09,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":6996.27,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":6996.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":7581.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":18686.56,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":7581.44,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":5392.09,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":9092.32,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":6719.19,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":7619.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":7481.16,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":7411.89,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. 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"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":7550.43,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":7245.64,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":6719.19,"methodology":"fee schedule"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":7342.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":8658.75,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":8145.22,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":7273.35,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":7273.35,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":7862.14,"methodology":"fee schedule"},{"payer_name":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":5392.09,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":6927.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6622.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":6927.00,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":6788.46,"methodology":"fee schedule"}]}]},{"description":"ACUTE LEUKEMIA WITH CC ","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":6000.00,"maximum":71417.01,"payers_information":[{"payer_name":"Access 2 Healthcare Physicians","plan_name":"MGMCR","standard_charge_dollar":15433.63,"methodology":"fee schedule"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":15587.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":16668.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. 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"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":17440.00,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"BSL","standard_charge_dollar":20607.69,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":27129.34,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":20607.69,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":15587.97,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":15587.97,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":28975.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":71417.01,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":28975.05,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"SBN","standard_charge_dollar":20607.69,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":20258.06,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":14970.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":16976.99,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"OAP","standard_charge_dollar":32532.51,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":47177.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":16668.32,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":16513.98,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15742.30,"methodology":"fee schedule"},{"payer_name":"Evolutions","plan_name":"DISCOUNTPPO","standard_charge_percentage":92.00,"standard_charge_algorithm":"Reimbursement will be 92% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"SELECTPPO","standard_charge_percentage":55.00,"standard_charge_algorithm":"Reimbursement will be 55% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Evolutions","plan_name":"TRADITIONALPPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":16668.32,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health Care","plan_name":"MCR","standard_charge_dollar":15587.97,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":16822.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":16143.58,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":14970.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":9814.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MGMCR","standard_charge_dollar":16359.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMPLEMENTARYPPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"PRIMARYPPO","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":19292.04,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"MCRHMO","standard_charge_dollar":15587.97,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PFFS","standard_charge_dollar":15587.97,"methodology":"fee schedule"},{"payer_name":"Optimum  Healthcare","plan_name":"PPO","standard_charge_dollar":15587.97,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":18147.89,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health ","plan_name":"COMM","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sheriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare","plan_name":"MGMCR","standard_charge_dollar":16205.31,"methodology":"fee schedule"},{"payer_name":"Suncoast Neighborly Care","plan_name":"LOCALGOV","standard_charge_dollar":16205.31,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":17517.17,"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":"TRULI FOR HEALTH","plan_name":"COMM","standard_charge_dollar":20607.69,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":15433.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8000.00,"methodology":"per diem","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $5525 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14754.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowIndividualExchange","standard_charge_dollar":6000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $345427.00, reimbursement will be $4047 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":27.10,"standard_charge_algorithm":"Reimbursement will be 27.1% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United VA CCN","plan_name":"FED","standard_charge_dollar":15433.63,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":15124.96,"methodology":"fee schedule"}]}]},{"description":"Acylcarnitines; qualitative, each specimen ","code_information":[{"code":"82016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.95,"maximum":23.91,"payers_information":[{"payer_name":"Aetna","plan_name":"GatedCOMM","standard_charge_percentage":11.60,"standard_charge_algorithm":"Reimbursement will be 11.6% of billable gross 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Health","plan_name":"MCR","standard_charge_dollar":18.14,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":17.48,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":17.31,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":16.82,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":20.61,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":18.14,"methodology":"fee schedule"},{"payer_name":"Cigna 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schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":211.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":195.32,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":201.36,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":291.97,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":211.43,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":205.39,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":201.36,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket ","code_information":[{"code":"L5648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":748.54,"maximum":1118.95,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":771.69,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":825.71,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":794.84,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":848.86,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":817.99,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":810.27,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":879.73,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":848.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":825.71,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":848.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":771.69,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":825.71,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":841.14,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":848.86,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":810.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":748.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":771.69,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":1118.95,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":810.27,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":787.12,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":771.69,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each ","code_information":[{"code":"L5695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":190.39,"maximum":284.61,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":196.28,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":210.02,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":202.17,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":215.91,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":208.06,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":206.09,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":200.21,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":200.21,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":223.76,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":215.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":210.02,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":215.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":196.28,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":210.02,"methodology":"fee schedule"},{"payer_name":"Gold Kidney 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schedule"}]}]},{"description":"Addition to lower extremity, below knee, waist belt, webbing ","code_information":[{"code":"L5688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":69.45,"maximum":103.82,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":73.75,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":78.76,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":75.90,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":75.18,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":81.62,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":78.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":78.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":76.61,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":78.04,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":78.76,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":75.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":69.45,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":103.82,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":75.18,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":71.60,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, extended steel shank ","code_information":[{"code":"L2360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55.21,"maximum":82.53,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":60.90,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":58.63,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":62.61,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":60.34,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":58.06,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":58.06,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":64.89,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":62.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":60.90,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":62.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":60.90,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":62.04,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":62.61,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":55.21,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":56.92,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":82.53,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":59.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":58.06,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":56.92,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, molded inner boot ","code_information":[{"code":"L2280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":518.05,"maximum":774.40,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":534.07,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":571.45,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":550.09,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":587.48,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":566.11,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":560.77,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":544.75,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":544.75,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":608.84,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":587.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":571.45,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":587.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":534.07,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":571.45,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":582.14,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":587.48,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":560.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":518.05,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":534.07,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":774.40,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":560.77,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":544.75,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":534.07,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, test socket, knee disarticulation ","code_information":[{"code":"L5622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":412.17,"maximum":616.13,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":424.92,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":454.66,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":437.67,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":467.41,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":450.42,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":446.17,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":433.42,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":433.42,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":484.41,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":454.66,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":424.92,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":454.66,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":463.16,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":467.41,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":446.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":412.17,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":424.92,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":616.13,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":446.17,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":433.42,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":424.92,"methodology":"fee schedule"}]}]},{"description":"Addition to tlso, (low profile), abdominal pad ","code_information":[{"code":"L1270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":105.54,"maximum":157.76,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":108.80,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":116.42,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":112.06,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":119.68,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":115.33,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":114.24,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":110.98,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":110.98,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":124.03,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":116.42,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":108.80,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":116.42,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":118.59,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":114.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":105.54,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":108.80,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":157.76,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":114.24,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":110.98,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":108.80,"methodology":"fee schedule"}]}]},{"description":"Addition to tlso, (low profile), rib gusset (elastic), each ","code_information":[{"code":"L1280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":94.06,"maximum":140.61,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":103.76,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":99.88,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":106.67,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":102.79,"methodology":"fee schedule"},{"payer_name":"BayCare Health Plans","plan_name":"MCR","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MCRPPO","standard_charge_dollar":98.91,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MGMCRHMO","standard_charge_dollar":98.91,"methodology":"fee schedule"},{"payer_name":"CarePlus","plan_name":"MGMCR","standard_charge_dollar":110.55,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"LOGOV","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"MCR","standard_charge_dollar":103.76,"methodology":"fee schedule"},{"payer_name":"Clear Spring Health","plan_name":"MCR","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":103.76,"methodology":"fee schedule"},{"payer_name":"Gold Kidney of Florida","plan_name":"Medicare","standard_charge_dollar":105.70,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":106.67,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"TRICARE","standard_charge_dollar":94.06,"methodology":"fee schedule"},{"payer_name":"NDMS Definitive Care","plan_name":"MCR","standard_charge_dollar":96.97,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_dollar":140.61,"methodology":"fee schedule"},{"payer_name":"Sunshine State","plan_name":"MCR","standard_charge_dollar":101.82,"methodology":"fee schedule"},{"payer_name":"Ultimate Health Plan","plan_name":"MCR","standard_charge_dollar":98.91,"methodology":"fee schedule"},{"payer_name":"WellMed","plan_name":"MGMCR","standard_charge_dollar":96.97,"methodology":"fee schedule"}]}]},{"description":"Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated ","code_information":[{"code":"L6895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":711.40,"maximum":1063.43,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":733.40,"methodology":"fee schedule"},{"payer_name":"Align Senior Care","plan_name":"MCR","standard_charge_dollar":784.74,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":755.40,"methodology":"fee schedule"},{"payer_name":"Alignment Health","plan_name":"MCR","standard_charge_dollar":806.74,"methodology":"fee schedule","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"American Health Plan","plan_name":"MCR","standard_charge_dollar":777.40,"methodology":"fee schedule"},{"payer_name":"BayCare Health 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