{"hospital_name":"HCA FLORIDA MERCY HOSPITAL","last_updated_on":"2024-10-01","version":"2.2.0","affirmation":{"affirmation":"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.","confirm_affirmation":true},"hospital_location":["HCA FLORIDA MERCY HOSPITAL"],"hospital_address":["3663 South Miami Ave, MIAMI, FL, 33133"],"license_information":{"hospital_license_number":"66","state":"FL"},"standard_charge_information":[{"description":"Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing ","code_information":[{"code":"22310","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9823.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9823.00,"methodology":"case rate"}]}]},{"description":"Closure of esophagostomy or fistula; cervical approach ","code_information":[{"code":"360","type":"RC"},{"code":"43420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Closure of lacrimal fistula (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"68770","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case 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charges.","estimated_amount":999.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":561.66,"methodology":"percent of total billed charges"}]}]},{"description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"44388","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case 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rate"}]}]},{"description":"Colonoscopy through stoma; with control of bleeding, any method ","code_information":[{"code":"361","type":"RC"},{"code":"44391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"361","type":"RC"},{"code":"44392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"44394","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique ","code_information":[{"code":"44394","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy through stoma; with transendoscopic balloon dilation ","code_information":[{"code":"369","type":"RC"},{"code":"44405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth 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","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":539.77,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1295.46,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1943.19,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1943.19,"methodology":"percent of total billed 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charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3598.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1943.19,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1705.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":942.81,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":762.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":525.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":525.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":1245.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1705.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":1245.08,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3598.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":7197.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":1007.58,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3598.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5757.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1151.52,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":669.32,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1655.31,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1655.31,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1943.19,"methodology":"percent of 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"45388","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"45388","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with endoscopic mucosal resection ","code_information":[{"code":"45390","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"360","type":"RC"},{"code":"45391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"369","type":"RC"},{"code":"45384","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case 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"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5080.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":9604.84,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":9436.34,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":8425.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":8256.79,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":8256.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":8256.79,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":8593.81,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":8425.30,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":8930.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":10531.63,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4716.25,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":8425.30,"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":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":8762.31,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":8930.82,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":102.00,"standard_charge_algorithm":"Reimbursement will be 102% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":9267.83,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":8509.55,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"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 $429020.00, reimbursement will be $7726 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":8425.30,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":8029.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  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","code_information":[{"code":"93622","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7350.00,"maximum":41198.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":27784.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":41198.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":37829.00,"methodology":"case rate"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":20858.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":20353.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":16302.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":12658.00,"methodology":"case rate"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":16201.00,"methodology":"case 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"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":54715.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":30168.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":114781.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":58200.12,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":45999.54,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":37146.43,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":37146.43,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":62903.16,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":114781.50,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":62903.16,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":35922.09,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":40456.50,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":57618.46,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":81929.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":36043.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":37514.21,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":37514.21,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":41927.65,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":41192.08,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":36043.07,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":36043.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":36043.07,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":37514.21,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":36778.64,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":38985.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":45973.30,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":29213.85,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":38249.79,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":38985.36,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":102.00,"standard_charge_algorithm":"Reimbursement will be 102% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":40456.50,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":37146.43,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":12590.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7726 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":35050.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":12590.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7726 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":36778.64,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":35675.28,"methodology":"fee schedule"}]}]},{"description":"Coronoidectomy (separate procedure) ","code_information":[{"code":"21070","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Coronoidectomy (separate procedure) ","code_information":[{"code":"21070","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Corpora cavernosa-glans penis fistulization (eg, biopsy needle, Winter procedure, rongeur, or punch) for priapism ","code_information":[{"code":"54435","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Correction of lid retraction ","code_information":[{"code":"67911","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Correction of trichiasis; incision of lid margin, with free mucous membrane graft ","code_information":[{"code":"361","type":"RC"},{"code":"67835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method ","code_information":[{"code":"28296","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9823.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9823.00,"methodology":"case rate"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method ","code_information":[{"code":"28299","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9823.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9823.00,"methodology":"case rate"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method ","code_information":[{"code":"28297","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9823.00,"methodology":"case rate"}]}]},{"description":"Corticosterone ","code_information":[{"code":"82528","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.29,"maximum":33.78,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":23.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":17.14,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":21.42,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":29.75,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.13,"methodology":"percent of total billed 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charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":14.28,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":28.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":12.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":8.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":8.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":20.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":28.20,"methodology":"percent of total billed 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charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":40.46,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":27.37,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":32.13,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":22.61,"methodology":"percent of total billed 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charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":95.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":101.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":59.50,"methodology":"percent of total billed 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logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3833.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3833.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"11311","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11312","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"11306","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11307","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11307","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm ","code_information":[{"code":"11308","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less ","code_information":[{"code":"11300","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"11301","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11302","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"11302","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm ","code_information":[{"code":"11303","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"SHEATH ACC 12-14FR 55CM ","code_information":[{"code":"800934","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1660.00,"discounted_cash":1660.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":273.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":317.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":239.04,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":298.80,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":415.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":365.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":199.20,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":393.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":217.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":175.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":287.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":393.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":287.18,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":1660.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":232.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":366.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":330.34,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1328.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":265.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":154.38,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to 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billable gross charges.","estimated_amount":154.38,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":215.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1328.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross 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charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1940.76,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1365.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6109.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":5391.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":668.48,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3594.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5750.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6109.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3594.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":970.38,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":10422.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3234.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1818.56,"methodology":"percent of total billed charges"}]}]},{"description":"Sialolithotomy; parotid, extraoral or complicated intraoral ","code_information":[{"code":"369","type":"RC"},{"code":"42340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), complicated, intraoral ","code_information":[{"code":"42335","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral ","code_information":[{"code":"42330","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral ","code_information":[{"code":"42330","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"SIG W/HBF OR BC ","code_information":[{"code":"117228","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6636.00,"discounted_cash":6636.00,"payers_information":[{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":497.70,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1194.48,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1791.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1791.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1791.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1791.72,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3318.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3318.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3318.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1791.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1572.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":869.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":703.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":484.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":484.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":1148.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":1572.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":1148.03,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3318.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":6636.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":929.04,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3318.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5308.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":1061.76,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":617.15,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":1526.28,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":1526.28,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":1791.72,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":1260.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5640.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4977.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":617.15,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3318.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5308.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5640.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":3318.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":895.86,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":9622.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2986.20,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":1678.91,"methodology":"percent of total billed charges"}]}]},{"description":"Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"45330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3833.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3833.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"45346","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"361","type":"RC"},{"code":"45350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) ","code_information":[{"code":"45350","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with biopsy, single or multiple ","code_information":[{"code":"45331","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3833.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3833.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with control of bleeding, any method ","code_information":[{"code":"361","type":"RC"},{"code":"45334","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with control of bleeding, any method ","code_information":[{"code":"45334","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case 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rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"361","type":"RC"},{"code":"45347","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"45347","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2628.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"361","type":"RC"},{"code":"45332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps ","code_information":[{"code":"45333","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case 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multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm ","code_information":[{"code":"12016","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, Lynch type) ","code_information":[{"code":"31075","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case 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","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polyps ","code_information":[{"code":"31030","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"867843","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1660.00,"discounted_cash":1660.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":273.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":124.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":317.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 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charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":154.38,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":381.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":348.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":564.40,"methodology":"percent of total billed 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billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2407.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":473.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":747.00,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":419.98,"methodology":"percent of total billed charges"}]}]},{"description":"SIZER BREAST 415CC ","code_information":[{"code":"927428","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":813.00,"discounted_cash":813.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":134.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":60.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":155.28,"methodology":"percent of total billed 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","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":59.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":59.35,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":140.65,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":192.68,"methodology":"percent of total billed 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"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":54961.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":64813.47,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":42236.35,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":51850.78,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":53924.81,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":54961.83,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":102.00,"standard_charge_algorithm":"Reimbursement will be 102% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":57035.86,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":52369.29,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":12867.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. 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"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":38323.05,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":37650.72,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":33616.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":11768.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":32944.38,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":32944.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":15160.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. 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billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":814.31,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":2046.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3273.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":654.72,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":380.56,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":941.16,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":859.32,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":1391.28,"methodology":"percent of total billed 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rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube ","code_information":[{"code":"361","type":"RC"},{"code":"44373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional 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billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":470.24,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1181.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1890.40,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":378.08,"methodology":"percent of total billed 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billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3426.35,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":673.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1063.35,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":597.84,"methodology":"percent 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","code_information":[{"code":"499","type":"RC"},{"code":"63610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2580.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":2628.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case 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charges"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":4.32,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":3.52,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":1.92,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":8.00,"methodology":"percent of total billed 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charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":2.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":1.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":1.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":1.17,"methodology":"percent of total billed 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","code_information":[{"code":"889056","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":125.00,"discounted_cash":125.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":20.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":9.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":23.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% 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","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":9.13,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":21.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":29.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":21.63,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health 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charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":24.88,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":62.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":100.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":20.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom 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charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":93.75,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":11.63,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":16.25,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":62.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":100.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":106.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":62.50,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":16.88,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":181.25,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":35.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":56.25,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":31.63,"methodology":"percent of 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rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (List separately in addition to code for primary procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"67340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (List separately in addition to code for primary procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"67331","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1326.00,"maximum":2948.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":2948.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1326.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Strabismus surgery, any procedure, superior oblique muscle ","code_information":[{"code":"361","type":"RC"},{"code":"67318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case 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dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Strabismus surgery, recession or resection procedure; 2 or more vertical muscles (excluding superior oblique) ","code_information":[{"code":"499","type":"RC"},{"code":"67316","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth 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","code_information":[{"code":"67316","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"STRAPPING TOES PT ","code_information":[{"code":"29550","type":"CPT"},{"code":"588010","type":"CDM"}],"standard_charges":[{"modifiers":"GP","modifiers_description":"Services delivered under an outpatient physical therapy plan of care","setting":"outpatient","gross_charge":517.00,"discounted_cash":517.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":85.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":98.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 14.4% of billable gross charges.","estimated_amount":74.45,"methodology":"percent of total billed charges"},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":93.06,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_percentage":25.00,"standard_charge_algorithm":"Reimbursement will be 25% of billable gross charges.","estimated_amount":129.25,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_percentage":22.00,"standard_charge_algorithm":"Reimbursement will be 22% of billable gross charges.","estimated_amount":113.74,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_percentage":12.00,"standard_charge_algorithm":"Reimbursement will be 12% of billable gross charges.","estimated_amount":62.04,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":258.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":258.50,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":258.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":258.50,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":517.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":72.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":114.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":102.88,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":258.50,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":413.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":82.72,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":48.08,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":118.91,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":108.57,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":175.78,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":139.59,"methodology":"percent of total billed 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","code_information":[{"code":"906465","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1473.00,"discounted_cash":1473.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":16.50,"standard_charge_algorithm":"Reimbursement will be 16.5% of billable gross charges.","estimated_amount":243.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_percentage":7.50,"standard_charge_algorithm":"Reimbursement will be 7.5% of billable gross charges.","estimated_amount":110.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":19.10,"standard_charge_algorithm":"Reimbursement will be 19.1% of billable gross charges.","estimated_amount":281.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":14.40,"standard_charge_algorithm":"Reimbursement will be 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charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":393.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":217.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":175.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":121.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":121.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":287.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":393.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":287.18,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":1660.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":232.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":366.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":330.34,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1328.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":265.60,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":154.38,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":381.80,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":348.60,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":564.40,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":381.80,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":448.20,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":315.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1411.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1245.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":154.38,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":215.80,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1328.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1411.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":830.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":224.10,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":2407.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross 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","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case 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logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2004.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":2004.00,"methodology":"case rate"}]}]},{"description":"Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc ","code_information":[{"code":"11951","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":3346.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":1848.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3833.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":3833.00,"methodology":"case rate"}]}]},{"description":"Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps ","code_information":[{"code":"499","type":"RC"},{"code":"61001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1848.00,"maximum":3833.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":3346.00,"methodology":"case 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","code_information":[{"code":"69120","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Excision 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charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":822.96,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":579.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2590.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2286.00,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":283.46,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":396.24,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1524.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2438.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime 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charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross charges.","estimated_amount":868.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1371.60,"methodology":"percent of total billed charges"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":25.30,"standard_charge_algorithm":"Reimbursement will be 25.3% of billable gross charges.","estimated_amount":771.14,"methodology":"percent of total billed charges"}]}]},{"description":"Canthoplasty (reconstruction of canthus) 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","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Canthotomy (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"67715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case 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charges"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1215.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":656.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":575.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_percentage":13.10,"standard_charge_algorithm":"Reimbursement will be 13.1% of billable gross charges.","estimated_amount":318.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_percentage":10.60,"standard_charge_algorithm":"Reimbursement will be 10.6% of billable gross charges.","estimated_amount":257.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":177.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_percentage":7.30,"standard_charge_algorithm":"Reimbursement will be 7.3% of billable gross charges.","estimated_amount":177.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":420.39,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_percentage":23.70,"standard_charge_algorithm":"Reimbursement will be 23.7% of billable gross charges.","estimated_amount":575.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_percentage":17.30,"standard_charge_algorithm":"Reimbursement will be 17.3% of billable gross charges.","estimated_amount":420.39,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1215.00,"methodology":"percent of total billed charges"},{"payer_name":"Beacon Health Options MCR","plan_name":"MCR","standard_charge_percentage":100.00,"standard_charge_algorithm":"Reimbursement will be 100% of billable gross charges.","estimated_amount":2430.00,"methodology":"percent of total billed charges"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_percentage":14.00,"standard_charge_algorithm":"Reimbursement will be 14% of billable gross charges.","estimated_amount":340.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_percentage":22.10,"standard_charge_algorithm":"Reimbursement will be 22.1% of billable gross charges.","estimated_amount":537.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_percentage":19.90,"standard_charge_algorithm":"Reimbursement will be 19.9% of billable gross charges.","estimated_amount":483.57,"methodology":"percent of total billed charges"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1215.00,"methodology":"percent of total billed charges"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1944.00,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_percentage":16.00,"standard_charge_algorithm":"Reimbursement will be 16% of billable gross charges.","estimated_amount":388.80,"methodology":"percent of total billed charges"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":225.99,"methodology":"percent of total billed charges"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges not to exceed $3200.","estimated_amount":558.90,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_percentage":21.00,"standard_charge_algorithm":"Reimbursement will be 21% of billable gross charges.","estimated_amount":510.30,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_percentage":34.00,"standard_charge_algorithm":"Reimbursement will be 34% of billable gross charges.","estimated_amount":826.20,"methodology":"percent of total billed charges"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_percentage":23.00,"standard_charge_algorithm":"Reimbursement will be 23% of billable gross charges.","estimated_amount":558.90,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_percentage":27.00,"standard_charge_algorithm":"Reimbursement will be 27% of billable gross charges.","estimated_amount":656.10,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"MCR","standard_charge_percentage":19.00,"standard_charge_algorithm":"Reimbursement will be 19% of billable gross charges not to exceed $3000.","estimated_amount":461.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2065.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1822.50,"methodology":"percent of total billed charges"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_percentage":9.30,"standard_charge_algorithm":"Reimbursement will be 9.3% of billable gross charges.","estimated_amount":225.99,"methodology":"percent of total billed charges"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_percentage":13.00,"standard_charge_algorithm":"Reimbursement will be 13% of billable gross charges.","estimated_amount":315.90,"methodology":"percent of total billed charges"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1215.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1944.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2065.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":1215.00,"methodology":"percent of total billed charges"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_percentage":13.50,"standard_charge_algorithm":"Reimbursement will be 13.5% of billable gross charges not to exceed $4200.","estimated_amount":328.05,"methodology":"percent of total billed charges"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":145.00,"standard_charge_algorithm":"Reimbursement will be 145% of billable gross charges.","estimated_amount":3523.50,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_percentage":28.50,"standard_charge_algorithm":"Reimbursement will be 28.5% of billable gross 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","code_information":[{"code":"27036","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":11151.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor muscles 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logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor muscles (ie, gluteus medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius, 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rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Capsulectomy or capsulotomy; interphalangeal joint, each joint ","code_information":[{"code":"26525","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":5318.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":4910.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2580.00,"methodology":"case rate"},{"payer_name":"Freedom 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rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5318.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":5318.00,"methodology":"case rate"}]}]},{"description":"Capsulodesis, metacarpophalangeal joint; 2 digits ","code_information":[{"code":"26517","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health 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","code_information":[{"code":"26518","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2702.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9823.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9823.00,"methodology":"case rate"}]}]},{"description":"Capsulodesis, metacarpophalangeal joint; single digit ","code_information":[{"code":"26516","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9823.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9823.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability ","code_information":[{"code":"25320","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":7571.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, anterior, any type; with bone block ","code_information":[{"code":"23460","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13865.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13865.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13865.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation ","code_information":[{"code":"23450","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":13865.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13865.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13865.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation ","code_information":[{"code":"23450","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4678.00,"maximum":13865.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13865.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":13865.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, glenohumeral joint, any type multidirectional instability ","code_information":[{"code":"23466","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":6926.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block ","code_information":[{"code":"23465","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block ","code_information":[{"code":"23465","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4296.00,"maximum":12077.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":12077.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":4296.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10009.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11151.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":11151.00,"methodology":"case rate"}]}]},{"description":"Capsulotomy, midfoot; medial release only (separate procedure) ","code_information":[{"code":"28260","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Capsulotomy, midfoot; medial release only (separate procedure) ","code_information":[{"code":"28260","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2927.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":4997.00,"methodology":"case rate"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":4678.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7165.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":7165.00,"methodology":"case rate"}]}]},{"description":"Capsulotomy, posterior capsular release, knee ","code_information":[{"code":"27435","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1495.00,"maximum":9823.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":8652.00,"methodology":"case rate"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":2927.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":1495.00,"methodology":"case rate"},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":2050.00,"methodology":"case rate"},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":2702.00,"methodology":"case rate","additional_payer_notes":"Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic."},{"payer_name":"Optimum","plan_name":"MGMCR","standard_charge_dollar":2350.00,"methodology":"case rate"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":7069.00,"methodology":"case rate"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":2160.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":9823.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":9823.00,"methodology":"case rate"}]}]},{"description":"Capsulotomy; interphalangeal joint, each joint (separate procedure) ","code_information":[{"code":"28272","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2350.00,"maximum":7915.00,"payers_information":[{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":7915.00,"methodology":"case 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","code_information":[{"code":"80161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.45,"maximum":27.96,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":19.20,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_percentage":12.20,"standard_charge_algorithm":"Reimbursement will be 12.2% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_percentage":10.30,"standard_charge_algorithm":"Reimbursement will be 10.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed 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"},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 4+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":14433.44,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":15299.56,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":10299.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":9457.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":5080.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":24777.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":12563.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":9929.90,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":15002.48,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":15002.48,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":13578.88,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":24777.83,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":13578.88,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":12629.07,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":16339.33,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":20256.83,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":28803.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":14556.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":15151.02,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":15151.02,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Freedom Health","plan_name":"MGMCR","standard_charge_dollar":16933.49,"methodology":"fee schedule"},{"payer_name":"Gold Kidney","plan_name":"MCR","standard_charge_dollar":16636.41,"methodology":"fee schedule"},{"payer_name":"Health Sun Health Plan","plan_name":"MGMCR","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"HMO","standard_charge_dollar":6240.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"HUMANA","plan_name":"MGMCRHMO","standard_charge_dollar":14556.86,"methodology":"fee schedule"},{"payer_name":"HUMANA","plan_name":"MGMCRPPO","standard_charge_dollar":14556.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"PPO","standard_charge_dollar":7491.00,"methodology":"case rate","additional_payer_notes":"Days 0 - 1. "},{"payer_name":"Leon Health","plan_name":"MCR","standard_charge_dollar":14556.86,"methodology":"fee schedule"},{"payer_name":"Longevity Health Plan","plan_name":"MCR","standard_charge_dollar":15151.02,"methodology":"fee schedule"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":690.00,"methodology":"case rate"},{"payer_name":"Medica HealthCare","plan_name":"MCR","standard_charge_dollar":1195.00,"methodology":"per diem"},{"payer_name":"MMM of FL (Health Advantage Plan)","plan_name":"MCR","standard_charge_dollar":14853.94,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"HIX","standard_charge_dollar":11098.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"Molina","plan_name":"MCR","standard_charge_dollar":15745.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"NDMS Definitive Care","plan_name":"MGMCR","standard_charge_dollar":18567.42,"methodology":"fee schedule"},{"payer_name":"Oscar","plan_name":"HIX","standard_charge_dollar":10270.67,"methodology":"fee schedule"},{"payer_name":"Oscar ","plan_name":"MCR","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"Plotkin Health","plan_name":"WORKERSCOMP","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"PPO","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health Sherriff","plan_name":"COMM","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Prominence HealthFirst","plan_name":"MCRHMO","standard_charge_dollar":15448.10,"methodology":"fee schedule"},{"payer_name":"Simply Healthcare Plans","plan_name":"MGMCR","standard_charge_dollar":15745.18,"methodology":"fee schedule"},{"payer_name":"Solis Health Plan","plan_name":"MCR","standard_charge_percentage":102.00,"standard_charge_algorithm":"Reimbursement will be 102% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Sunshine State ","plan_name":"MCD","standard_charge_dollar":16339.33,"methodology":"fee schedule"},{"payer_name":"Sunshine State ","plan_name":"MCR","standard_charge_dollar":15002.48,"methodology":"fee schedule"},{"payer_name":"Sunshine State Health Plan","plan_name":"QHP","standard_charge_dollar":9359.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7726 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefitPlanAppendix","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GVT","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"United   ","plan_name":"MCR","standard_charge_dollar":14155.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"NarrowNetworkIndividualExchange","standard_charge_dollar":10000.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $429020.00, reimbursement will be $7726 per diem instead of the contracted rate."},{"payer_name":"United Behavioral Health","plan_name":"VACCN","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"United PPO","plan_name":"OptionsPPO","standard_charge_percentage":40.30,"standard_charge_algorithm":"Reimbursement will be 40.3% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Veterans Evaluation Services","plan_name":"MCR","standard_charge_dollar":14853.94,"methodology":"fee schedule"},{"payer_name":"Wellmed","plan_name":"MGMCR","standard_charge_dollar":14408.32,"methodology":"fee schedule"}]}]},{"description":"CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA ","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":690.00,"maximum":219087.00,"payers_information":[{"payer_name":"Aetna","plan_name":"HMO","standard_charge_dollar":91691.00,"methodology":"case rate"},{"payer_name":"Aetna ","plan_name":"MCR","standard_charge_dollar":55584.90,"methodology":"fee schedule"},{"payer_name":"Aetna","plan_name":"PPO","standard_charge_dollar":106587.00,"methodology":"case rate"},{"payer_name":"Aetna","plan_name":"QHP","standard_charge_dollar":73536.00,"methodology":"case rate"},{"payer_name":"Align","plan_name":"MCR","standard_charge_dollar":55313.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"American Health Plan ","plan_name":"MCR","standard_charge_dollar":1275.00,"methodology":"per diem","additional_payer_notes":"Days 6+. "},{"payer_name":"AmeriHealth Caritas","plan_name":"HIX","standard_charge_dollar":62242.88,"methodology":"fee schedule"},{"payer_name":"AmeriHealth Caritas","plan_name":"MGMCR","standard_charge_dollar":55856.05,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"ASOEO","standard_charge_dollar":88282.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"Empower","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Engage","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Flex","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"Focus","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"AvMed","plan_name":"FullyInsured","standard_charge_dollar":81059.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"HIX","standard_charge_dollar":49143.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 6. "},{"payer_name":"AvMed","plan_name":"JacksonFirstNetworkOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"JHSSelectHMO","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed ","plan_name":"MCR","standard_charge_dollar":54229.17,"methodology":"fee schedule"},{"payer_name":"AvMed","plan_name":"MDCSelectOON","standard_charge_percentage":50.00,"standard_charge_algorithm":"Reimbursement will be 50% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"AvMed","plan_name":"Select","standard_charge_dollar":5349.00,"methodology":"per diem"},{"payer_name":"BCBS","plan_name":"BSLNON-PAR","standard_charge_dollar":202811.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"HMO","standard_charge_dollar":102835.68,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"MBN","standard_charge_dollar":81278.08,"methodology":"case rate"},{"payer_name":"BCBS ","plan_name":"MCRHMO","standard_charge_dollar":54771.46,"methodology":"fee schedule"},{"payer_name":"BCBS ","plan_name":"MCRPPO","standard_charge_dollar":54771.46,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"NWB","standard_charge_dollar":111145.63,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PHS","standard_charge_dollar":202811.15,"methodology":"fee schedule"},{"payer_name":"BCBS","plan_name":"PPO","standard_charge_dollar":111145.63,"methodology":"fee schedule"},{"payer_name":"Bright Health ","plan_name":"HIX","standard_charge_dollar":54461.71,"methodology":"fee schedule"},{"payer_name":"CarePlus SFL","plan_name":"MGMCR","standard_charge_dollar":54229.17,"methodology":"fee schedule"},{"payer_name":"Centurion","plan_name":"GVT","standard_charge_dollar":59652.09,"methodology":"fee schedule"},{"payer_name":"Cigna","plan_name":"ManagedCareHMO","standard_charge_dollar":76162.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna","plan_name":"PPO","standard_charge_dollar":91088.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. "},{"payer_name":"Cigna HealthSpring ","plan_name":"MGMCR","standard_charge_dollar":53144.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCR","standard_charge_dollar":55313.75,"methodology":"fee schedule"},{"payer_name":"Doctors Healthcare Plan","plan_name":"MCR","standard_charge_dollar":54229.17,"methodology":"fee schedule"},{"payer_name":"Evernorth BH","plan_name":"COMM","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Florida Complete Care","plan_name":"MCR","standard_charge_dollar":55313.75,"methodology":"fee schedule","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"Freedom Health","plan_name":"MGMCD","standard_charge_dollar":26750.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 8. 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